Abstract
Objective
To quantify in vivo spinal motions and coupling patterns occurring in human subjects
in response to mechanical force, manually assisted, short-lever spinal manipulative
thrusts (SMTs) applied to varying vertebral contact points and utilizing various excursion
(force) settings.
Methods
Triaxial accelerometers were attached to intraosseous pins rigidly fixed to the L1,
L3, or L4 lumbar spinous process of 4 patients (2 male, 2 female) undergoing lumbar
decompressive surgery. Lumbar spine acceleration responses were recorded during the
application of 14 externally applied posteroanterior (PA) impulsive SMTs (4 force
settings and 3 contact points) in each of the 4 subjects. Displacement time responses
in the PA, axial (AX), and medial-lateral (ML) axes were obtained, as were intervertebral
(L3-4) motion responses in 1 subject. Statistical analysis of the effects of facet
joint (FJ) contact point and force magnitude on peak-to-peak displacements was performed.
Motion coupling between the 3 coordinate axes of the vertebrae was examined using
a least squares linear regression.
Results
SMT forces ranged from 30 N (lowest setting) to 150 N (maximum setting). Peak-to-peak
ML, PA, and AX vertebral displacements increased significantly with increasing applied
force. For thrusts delivered over the FJs, pronounced coupling was observed between
all axes (AX-ML, AX-PA, PA-ML) (linear regression, R2 = 0.35-0.52, P < .001), whereas only the AX and PA axes showed a significant degree of coupling
for thrusts delivered to the spinous processes (SPs) (linear regression, R2 = 0.82, P < .001). The ML and PA motion responses were significantly (P < .05) greater than the AX response for all SMT force settings. PA vertebral displacements
decreased significantly (P < .05) when the FJ contact point was caudal to the pin compared with FJ contact cranial
to the pin. FJ contact at the level of the pin produced significantly greater ML vertebral
displacements in comparison with contact above and below the pin. SMTs over the spinous
processes produced significantly (P < .05) greater PA and AX displacements in comparison with ML displacements. The combined
ML, PA, and AX peak-to-peak displacements for the 4 force settings and 2 contact points
ranged from 0.15 to 0.66 mm, 0.15 to 0.81 mm, and 0.07 to 0.45 mm, respectively. Intervertebral
motions were of similar amplitude as the vertebral motions.
Conclusions
In vivo kinematic measurements of the lumbar spine during the application of SMTs
over the FJs and SPs corroborate previous spinous process measurements in human subjects.
Our findings demonstrate that PA, ML, and AX spinal motions are coupled and dependent
on applied force and contact point.
Keywords
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Article info
Publication history
Received in revised form:
September 6,
2002
Received:
June 12,
2002
Identification
Copyright
© 2003 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
