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Chiropractic Research Review

Variations in Intervertebral Motion Between Flexion and Extension in Asymptomatic Subjects

Previous studies have shown that abnormalities in intervertebral motion (IVM) provide crucial diagnostic information in the evaluation of patients reporting neck pain. Radiographs focusing on flexion and extension are commonly used to identify IVM abnormalities, which can be used to analyze each intervertebral level; however, IVM data has varied and thus remains poorly understood.

The objective of this study was to "gain further insight into intervertebral motion during flexion and extension in asymptomatic individuals, identify factors that contribute to variation in motion, and establish a quantitative database using a clinically practical imaging tool" and to ultimately "provide clinically useful information that can help reduce errors when assessing abnormalities in IVM from flexion-extension radiographs."

Fluoroscopic images of the cervical spine in maximum flexion and extension were analyzed in 140 subjects ranging in ages 18 to over 64, none of whom had ever experienced neck pain or symptoms requiring the intervention of a physician.

According to researchers, "Four IVM measures were calculated for each intervertebral level: 1) sagittal rotation (angular change with flexion and extension; 2) shear (defined as displacement of the posterior inferior corner of the superior vertebra in the direction defined by the superior endplate of the inferior vertebra); 3) displacement between the anterior aspects of the vertebrae; and 4) displacement between the posterior aspects of the vertebrae."

Conclusions: Researchers found significant variations in measured IVM and that "intervertebral level and total gross rotation between C2 and C6 significantly affected all measures of intervertebral motion." Other significant findings included the interrelation between the IVM measures and that "intervertebral levels and the three displacement measures could be used to explain almost 90% of the variation in sagittal plane intervertebral rotations," after adjusting for differences in gross motion between C2 and C6.

The authors suggest that "Clinically acceptable values for shear at C2-C3, C3-C4, and C5-C6 should be raised to 4.5mm and should be raised to 5.5mm for C4-C5 (assuming 30% image magnification)" and that their findings establish a database of IVM in asymptomatic subjects representing a wide age range and both sexes, which should aid in clinical interpretation of IVM in the cervical spine.

Reitman CA, Mauro KM, Nguyen L, et al. Intervertebral motion between flexion and extension in asymptomatic individuals. Spine 2004;29(24):2832-2843.

Chiropractic Research Review

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