Midlumbar lateral flexion stability measured in healthy volunteers by in vivo fluoroscopy

Abstract

Study Design: prospective fluoroscopic and electromyographic study of coronal plane lumbar spine motion in healthy male volunteers.

Objectives: assess the intervertebral motion profiles in healthy volunteers for symmetry, regularity, and neutral zone laxity during passive recumbent lateral bending motion.

Summary of background data: previous continuous in vivo motion studies of the lumbar spine have mainly been limited to active, weight-bearing, flexion-extension (sagittal plane) motion. No data are available for passive lateral bending or to indicate the motion profiles when muscle activity is minimized.

Methods: thirty asymptomatic male volunteers underwent video-fluoroscopy of their lumbar spines during passive, recumbent lumbar lateral bending through 80° using a motor-driven motion table. Approximately 120 consecutive images of segments L2–L5 were captured, and the position of each vertebra was tracked throughout the sequence using automated frame-to-frame registration. Reference intervals for intervertebral motion parameters were calculated. Surface electromyography recordings of erector spinae were obtained in a similar group of volunteers using the same protocol without fluoroscopy to determine to what extent the motion was completely passive.

Results: correlations between intervertebral and lumbar motion were always positive in controls and asymmetry was less than 55% of intervertebral range. The upper reference interval for the slope of intervertebral rotation in the first 10° of trunk motion did not exceed 0.46 for any level. Muscle electrical activity during the motion
was very low. Examples from patient studies showed markedly different results.

Conclusion: these results suggest that reference limits from asymptomatic data for coronal plane passive recumbent intervertebral motion may be a useful resource for
investigating the relationship between symptoms of chronic (nonspecific) low back pain and biomechanics and in the clinical assessment of patients and interventions
that target the passive holding elements of the spine. Data pooling from multiple studies would be necessary to establish a complete database

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