Cervical motion segment contributions to head motion during flexion\extension, lateral bending, and axial rotation

Abstract Background Context Cervical spine segmental contributions to motion may reveal movement abnormalities associated with whiplash, disc herniation, disc arthroplasty, or fusion. Purpose The objective of this study was to determine the cervical spine segmental contributions to head flexion\extension, lateral bending, and axial rotation during dynamic motion in young, healthy individuals. Study Design The study design was a descriptive control study. Patient Sample Twenty-nine young (20–35 years of age) healthy individuals comprised the patient sample. Outcome Measures Physiologic measures of contributions from each cervical motion segment to the primary head rotation were the outcome measures for this study. Methods Twenty-nine healthy participants performed full range of motion (ROM) flexion\extension, lateral bending, and axial rotation while biplane radiographs were collected at 30 images per second. Surface-based markers were used to determine head kinematics for each movement, and a validated volumetric model-based tracking technique was used to determine intervertebral kinematics. Contributions from each cervical motion segment to the primary head rotation were determined continuously during each of the three head movements. This study was funded by Synthes Spine (F). Results For each head movement, motion segments in the lower cervical spine increased their contributions to head motion near the end of the ROM. Cervical motion segment contributions to left and right lateral bending were mirror images of each other, as were contributions to left and right axial rotation. However, cervical motion segment contributions to flexion were not mirror images of the contributions to extension. Conclusions Cervical motion segment contributions to head motion change over the full ROM and cannot be accurately characterized solely from endpoint data. The continuously changing segmental contributions suggest that the compressive and shear loads applied to each motion segment also change over the ROM. The clinical implication of increased contributions from the inferior motions segments near the end ROM is that the clinician may advise the patient to avoid end ROM positions to lessen the demand on the discs of inferior motion segments.