Takahito Fujimori, MD, PhD
The Spine Journal
Available online 10 December 2013 In Press

Abstract

Background Context

In vivo three-dimensional kinematics of the thoracic spine in trunk lateral bending with an intact rib cage and soft tissues has not been well documented. There is no quantitative data in the literature for lateral bending in consecutive thoracic spinal segments, and there has not been consensus on the patterns of coupled motion with lateral bending.

Purpose

To demonstrate segmental range of motions in lateral bending and coupled motions of the thoracic spine.

Study Design

In vivo three-dimensional biomechanics study of the thoracic spine.

Patient Sample

Fifteen healthy male volunteers.

Outcome Measures

Computed analysis by using voxel-based registration.

Method

Participants underwent computed tomography of the thoracic spine in 3 supine positions: neutral, right maximum lateral bending, and left maximum lateral bending. The relative motions of vertebrae were calculated by automatically superimposing an image of vertebrae in a neutral position over images in bending positions, using voxel-based registration. Mean values of lateral bending was compared among the upper (T1–T2 to T3–T4), the middle-upper (T4–T5 to T6–T7), the middle-lower (T7–T8 to T9–T10), and the lower (T10–T11 to T12–L1) parts of the spine.

Results

At lateral bending, the mean range of motion (± standard deviation) of T1 with respect to L1 was 15.6° ± 6.3° for lateral bending and 6.2° ± 4.8° for coupled axial rotation in the same direction as lateral bending. The mean lateral bending of each spinal segment with respect to the inferior adjacent vertebra was 1.4° ± 1.3° at T1–T2, 1.3° ± 1.2° at T2–T3, 1.4° ± 1.3° at T3–T4, 0.9° ± 0.9° at T4–T5, 0.8° ± 1.0° at T5–T6, 1.1° ± 1.1° at T6–T7, 1.7° ± 1.2° at T7–T8, 1.3° ± 1.2° at T8–T9, 1.6° ± 0.7° at T9–T10, 1.8° ± 0.8° at T10–T11, 2.3° ± 1.0° at T11–T12, and 2.2° ± 0.8° at T12–L1. The smallest and the largest amounts of lateral bending were observed in the middle-upper part and the lower part, respectively. There was no significant difference in lateral bending between the upper and the middle-lower parts. Coupled axial rotation of each segment was generally observed in the same direction as lateral bending. However, high variability was found at the T2–T3 to T5–T6 segments. Coupled flexion was observed at the upper and middle parts, and coupled extension was observed at the lower part.

Conclusion

This study revealed in vivo three-dimensional motions of consecutive thoracic spinal segments in trunk lateral bending. The thoracolumbar segments significantly contributed to lateral bending. Coupled axial rotation generally occurred in the same direction with lateral bending. However, more variability was observed in the direction of coupled axial rotation at T2–T3 to T5–T6 segments in the supine position. These results are useful for understanding normal kinematics of the thoracic spine.

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Journal Reference: http://www.sciencedirect.com/science/article/pii/S1529943013019694