title: CT imaging techniques for describing motions of the cervicothoracic junction and cervical spine during flexion, extension, and cervical traction.
abstract: METHODS
  Computerized tomographic study of human cadavers undergoing traction and flexion-extension bending.
  
  
  OBJECTIVE
  To investigate the feasibility of using computerized tomography techniques to quantify relative vertebral motions of the cervical spine and cervicothoracic junction (CTJ), and to define normative CTJ kinematics.
  
  
  BACKGROUND
  Despite developing an understanding of the mechanical behavior of the cervical spine, little remains known about the cervicothoracic junction. The CTJ is more difficult to image than other cervical regions given the anatomic features of the surrounding bones obstructing CTJ visualization. As such, limited data have been reported describing the responses of the CTJ for motions and loading in the sagittal plane, confounding the clinical assessment of its injuries and surgical treatments used at this region.
  
  
  METHODS
  Helical CT images of the cervical spine and CTJ were acquired incrementally during each of flexion, extension, and cervical traction. Vertebral surfaces were reconstructed using the specialized image analysis software, 3DVIEWNIX. A mathematical description of relative vertebral motions was derived by computing rigid transformations. Euler angles and translations were calculated. Regional spine stiffness was defined for traction.
  
  
  RESULTS
  The CTJ was found to be much stiffer (779 N/mm) than the cervical spine (317 N/mm) in tension. In flexion-extension bending, the CTJ was similar to the lower cervical spine. The CTJ demonstrated significantly less coupled motion than the cervical spine.
  
  
  CONCLUSIONS
  The CTJ, as a transition region between the cervical and thoracic spines, has unique kinematic characteristics. This application of kinematic CT methods is useful for quantifying unreported normative ranges of motion for the CTJ, difficult by other conventional radiologic means.
authors.affiliation: Department of Neurosurgery, University of Pennsylvania, Philadelphia, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Simon
authors.forename: Martin
authors.initials: M
authors.lastname: Davis
authors.forename: Dewey
authors.initials: D
authors.lastname: Odhner
authors.forename: Jayaram
authors.initials: J
authors.lastname: Udupa
authors.forename: Beth
authors.initials: B
authors.lastname: Winkelstein
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology*; D016059:Range of Motion, Articular / Q000502:physiology*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000502:physiology*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014143:Traction