Wu Shyi-Kuen, Kuo Li-Chieh, Lan Haw-Chang H, Tsai Sen-Wei, Chen Chiung-Ling, Su Fong-Chin
Institute of Biomedical Engineering, National Cheng Kung University, 1 University Road, Tainan 701, Taiwan.
Eur Spine J. 2007 Sep;16(9):1435-44. doi: 10.1007/s00586-007-0372-4. Epub 2007 Apr 27.
The insufficient exploration of intervertebral translation during flexion and extension prevents the further understanding of the cervical biomechanics and treating the cervical related dysfunction. The objective of this study was to quantitatively measure the continuous intervertebral translation of healthy cervical spine during flexion and extension by videofluoroscopic technique. A total of 1,120 image sequences were analyzed for 56 healthy adult subjects by a precise image protocol during cervical flexion and extension. O: ur results showed there were no statistical angular differences among five spinal levels in either flexion or extension, except for the comparison between C2/3 (13.5 degrees) and C4/5 (22.6 degrees) angles. During cervical flexion, the smallest anterior translations were 0.7 mm at C2/3 level, followed by 0.9 mm at C6/7, 1.0 mm at C3/4, 1.1 mm at C5/6, and the largest 1.2 mm at C4/5 levels. The significantly greater translations were measured in the posterior direction at C3/4 (1.1 mm, P = 0.037), C4/5 (1.3 mm, P = 0.039), and C5/6 (1.2 mm, P = 0.005) levels than in the anterior one. The relatively fluctuant and small average posterior translation fashion at C6/7 level (0.4 mm) possibly originated from the variations in the direction of translation during cervical extension among subjects. Normalization with respect to the widths of individual vertebrae showed the total translation percentages relative to the adjacent vertebrae were 9.5, 13.7, 16.6, 15.0, and 8.6% for C2/3 to C6/7 levels, respectively, and appeared to be within the clinical-accepted ranges of translation in cervical spine. The intervertebral translations of cervical spine during flexion and extension movements were first described in quality and quantity based on the validated radiographic protocol. This analysis of the continuous intervertebral translations may be further employed to diagnose translation abnormalities like hypomobility or hypermobility and to monitor the treatment effect on cervical spines.
在屈伸过程中对椎间平移的探索不足，阻碍了对颈椎生物力学的进一步理解以及对颈椎相关功能障碍的治疗。本研究的目的是通过视频荧光透视技术定量测量健康颈椎在屈伸过程中的连续椎间平移。采用精确的图像协议，对56名健康成年受试者在颈椎屈伸过程中的1120个图像序列进行了分析。结果显示，除了C2/3（13.5度）和C4/5（22.6度）角度之间的比较外，五个脊柱节段在屈伸时均无统计学角度差异。在颈椎前屈时，C2/3节段的最小前向平移为0.7毫米，其次是C6/7节段的0.9毫米、C3/4节段的1.0毫米、C5/6节段的1.1毫米，最大的是C4/5节段的1.2毫米。在C3/4（1.1毫米，P = 0.037）、C4/5（1.3毫米，P = 0.039）和C5/6（1.2毫米，P = 0.005）节段，后向平移明显大于前向平移。C6/7节段相对波动且较小的平均后向平移方式（0.4毫米）可能源于受试者颈椎后伸时平移方向的变化。相对于各椎体宽度进行归一化处理后，C2/3至C6/7节段相对于相邻椎体的总平移百分比分别为9.5%、13.7%、16.6%、15.0%和8.6%，似乎在颈椎临床可接受的平移范围内。基于经过验证的影像学协议，首次对颈椎屈伸运动过程中的椎间平移进行了定性和定量描述。这种对连续椎间平移的分析可能会进一步用于诊断平移异常，如活动度降低或活动度过高，并监测对颈椎的治疗效果。
