Diagnostic imaging practice guidelines for musculoskeletal complaints in adults-an evidence-based approach-part 3: spinal disorders.

Vertebral axial rotation measurement method

The primary objective of the study involved the identification and quantification of systematic errors associated with the measurement of sacral obliquity on radiographic images. A secondary objective was to provide an estimate of true sacral obliquity derived from measurements made on radiographic images of the spine that could be used in a clinical setting to correct or reduce frontal plane obliquity. Methods used in the study included graphical, radiographic and mathematical models. They were used to evaluate the measurement of dihedral angles such as structural asymmetry of the sacral base and vertebral endplates in the frontal plane. A radiographic phantom was imaged using plain film, CT, and slot scan (scout) views. The variation of measurements using different views was compared to the known sacral obliquity value of the phantom. Results obtained from the studies demonstrate that different radiographic and analytical methods produced significant differences in the measurements of sacral obliquity for each of the imaging modalities and analytical methods. The study developed, tested and validated algorithms to calculate true dihedral angles from angles measured on radiographic images. The algorithms were designed to be employed when the protocols developed to ensure reliable measurement of angular relationships were not met or were unable to be adhered to. The measurement of sacral obliquity on radiographic images was used in the development of algorithms to calculate the amount of correction needed to level the sacral base in upright standing and sitting postures. Trigonometric techniques were developed and applied to measurements of sacral obliquity obtained from radiographic images of the erect spine to provide accurate dimensions of ischial or foot orthotics that would be required to level the sacral base in sitting or standing posture respectively.

The measurement and correction of sacral obliquity

A biomechanical study of lateral translation in lumbar spine with human cadavers was performed in order to explore the direction of the force increasing lateral translation and the contributions of discs and facet joints to lateral translation. Whole lumbar spines from 12 fresh cadavers were attached to a specially designed loading apparatus whose five cables simulated the muscles of the trunk without restricting natural movement. Three-dimensional positions of each vertebra were recorded with position-sensitive detectors. Force in the anterolateral direction increased the lateral translation more than force in the posterolateral direction. Lateral translation was increased to a significantly greater extent when the facet joints were removed than when the discs were removed at L4-5 at the levels of shear loading applied in this study.

Lateral Translation of the Lumbar Spine: In Vitro Biomechanical Study

Movement of the Projected Pedicles Relative to the Projected Vertebral Body in a Fourth Lumbar Vertebra During Axial Rotation

The Effects of Combined X-axis Translations and Y-axis Rotations on Projected Lamina Junction Offset

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The Effects of Combined X-axis Translations and Y-axis Rotations on Projected Lamina Junction Offset