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  • Title: Assessment of three-dimensional lumbar spine vertebral motion during gait with use of indwelling bone pins.
    Author: MacWilliams BA, Rozumalski A, Swanson AN, Wervey RA, Dykes DC, Novacheck TF, Schwartz MH.
    Journal: J Bone Joint Surg Am; 2013 Dec 04; 95(23):e1841-8. PubMed ID: 24306707.
    Abstract:
    BACKGROUND: This study quantifies the three-dimensional motion of lumbar vertebrae during gait via direct in vivo measurement with the use of indwelling bone pins with retroreflective markers and motion capture. Two previous studies in which bone pins were used were limited to instrumentation of two vertebrae, and neither evaluated motions during gait. While several imaging-based studies of spinal motion have been reported, the restrictions in measurement volume that are inherent to imaging modalities are not conducive to gait applications. METHODS: Eight healthy volunteers with a mean age of 25.1 years were screened to rule out pathology. Then, after local anesthesia was administered, two 1.6-mm Kirschner wires were inserted into the L1, L2, L3, L4, L5, and S1 spinous processes. The wires were clamped together, and reflective marker triads were attached to the end of each wire couple. Subjects underwent spinal computed tomography to anatomically register each vertebra to the attached triad. Subjects then walked several times in a calibrated measurement field at a self-selected speed while motion data were collected. RESULTS: Less than 4° of lumbar intersegmental motion was found in all planes. Motions were highly consistent between subjects, resulting in small group standard deviations. The largest motions were in the coronal plane, and the middle lumbar segments exhibited greater motions than the segments cephalad and caudad to them. Intersegmental lumbar flexion and axial rotation motions were both extremely small at all levels. CONCLUSIONS: The lumbar spine chiefly acts to contribute abduction during stance and adduction during swing to balance the relative motions between the trunk and pelvis. The lumbar spine acts in concert with the thoracic spine. While the lumbar spine chiefly contributes coronal plane motion, the thoracic spine contributes the majority of the transverse plane motion. Both contribute flexion motion in an offset phase pattern. CLINICAL RELEVANCE: This is a valid model for measuring the three-dimensional motion of the spine. Normative data were obtained to better understand the effects of spine disorders on vertebral motion over the gait cycle.
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