title: The shift of segmental contribution ratio in patients with herniated disc during cervical lateral bending.
abstract: BACKGROUND
  Abnormal intervertebral movements of spine have been reported to be associated with trauma and pathological conditions. The importance of objective spinal motion imaging assessment in the frontal plane was frequently underestimated. The clinical evaluation of the segmental motion contribution could be useful for detecting the motion pattern of individual vertebrae. Therefore the purpose of this study was to investigate the shift of segmental contribution ratio in patients with herniated disc during cervical lateral bending to provide additional insights to cervical biomechanics.
  
  
  METHODS
  A total of 92 subjects (46 healthy adult subjects and 46 disc-herniated patients) were enrolled in this case-control study. The motion images during cervical lateral bending movements were digitized using a precise image protocol to analyze the intervertebral motion and contribution.
  
  
  RESULTS
  Our results showed that the intervertebral angulation during cervical lateral bending for the C2/3 to C6/7 segments were 7.66°±2.37°, 8.37°±2.11°, 8.91°±3.22°, 7.19°±2.29°, 6.31°±2.11°, respectively for the healthy subjects. For the patients with herniated disc, the intervertebral angulation for the C2/3 to C6/7 segments were 6.87°±1.67°, 7.83°±1.79°, 7.73°±2.71°, 5.13°±2.05°, 4.80°±1.93°, respectively. There were significant angulation and translational differences between healthy subjects and the patients with herniated disc in the C5/6 and C6/7 segments (P=0.001-0.029). The segmental contributions of the individual vertebral segments were further analyzed. There was a significant increase in segmental contribution ratio of C3/4 (P=0.048), while a significant decrease in contribution ratio of C5/6 (P=0.037) was observed in the patients with herniated disc. Our results indicated that the segmental contribution shifted toward the middle cervical spine in the patients with herniated disc.
  
  
  CONCLUSIONS
  The segmental contributions of cervical spine during lateral bending movement were first described based on the validated radiographic protocol. The detection of the shift of segmental contribution ratio could be helpful for the diagnosis the motion abnormality resulted from the disc or, facet pathologies, and arthritic changes of cervical spine.
authors.forename: Haw-Chang H
authors.initials: HC
authors.lastname: Lan
authors.forename: Han-Yu
authors.initials: HY
authors.lastname: Chen
authors.forename: Li-Chieh
authors.initials: LC
authors.lastname: Kuo
authors.forename: Jia-Yuan
authors.initials: JY
authors.lastname: You
authors.forename: Wei-Chun
authors.initials: WC
authors.lastname: Li
authors.affiliation: Department of Physical Therapy, HungKuang University, No, 1018, Sec, 6, Taiwan Boulevard, Taichung, Shalu District 43302, Taiwan. skwu@sunrise.hk.edu.tw.
authors.forename: Shyi-Kuen
authors.initials: SK
authors.lastname: Wu
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000503:physiopathology*; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011237:Predictive Value of Tests; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D014741:Video Recording; D055815:Young Adult
references.citation: Spine (Phila Pa 1976). 2009 Oct 15;34(22):2389-94
references.pmid: 19829252
references.citation: J Bone Joint Surg Am. 2007 May;89(5):1066-74
references.pmid: 17473145
references.citation: Man Ther. 2001 Nov;6(4):235-41
references.pmid: 11673934
references.citation: J Manipulative Physiol Ther. 2001 Sep;24(7):445-8
references.pmid: 11562652
references.citation: Spine (Phila Pa 1976). 2006 Jan 15;31(2):155-60
references.pmid: 16418633
references.citation: J Neurol Neurosurg Psychiatry. 2011 May;82(5):561-3
references.pmid: 21047885
references.citation: J Manipulative Physiol Ther. 2002 Nov-Dec;25(9):550-5
references.pmid: 12466772
references.citation: J Manipulative Physiol Ther. 2006 Sep;29(7):511-7
references.pmid: 16949939
references.citation: Clin Biomech (Bristol, Avon). 2005 Feb;20(2):126-9
references.pmid: 15621315
references.citation: BMC Musculoskelet Disord. 2010 Sep 27;11:222
references.pmid: 20875135
references.citation: Spine (Phila Pa 1976). 2001 Dec 15;26(24):2692-700
references.pmid: 11740357
references.citation: BMC Musculoskelet Disord. 2006 May 19;7:45
references.pmid: 16709258
references.citation: Spine J. 2010 Dec;10(12):1069-77
references.pmid: 21094468
references.citation: Clin Radiol. 2002 Apr;57(4):241-9
references.pmid: 12014867
references.citation: Spine (Phila Pa 1976). 1988 Jul;13(7):748-55
references.pmid: 3194782
references.citation: BMC Musculoskelet Disord. 2010 Aug 26;11:189
references.pmid: 20738885
references.citation: BMC Musculoskelet Disord. 2006 Jan 04;7:1
references.pmid: 16393336
references.citation: Clin Biomech (Bristol, Avon). 2002 Jan;17(1):21-31
references.pmid: 11779643
references.citation: Int J Legal Med. 2004 Aug;118(4):235-9
references.pmid: 15197558
references.citation: J Manipulative Physiol Ther. 2006 Sep;29(7):570-5
references.pmid: 16949947
references.citation: BMC Musculoskelet Disord. 2012 Jan 31;13:10
references.pmid: 22293092
references.citation: J Spinal Disord Tech. 2010 Jun;23(4):278-84
references.pmid: 20068468
references.citation: Spine (Phila Pa 1976). 2006 Jun 1;31(13):E394-9
references.pmid: 16741439
references.citation: Clin Biomech (Bristol, Avon). 2000 Nov;15(9):633-48
references.pmid: 10946096
references.citation: J Rehabil Res Dev. 2004 Jul;41(4):631-9
references.pmid: 15558391
references.citation: Emerg Radiol. 2002 Nov;9(5):249-53
references.pmid: 15290548
references.citation: Spine (Phila Pa 1976). 2000 Jul 1;25(13):1625-36
references.pmid: 10870137
references.citation: Spine (Phila Pa 1976). 1989 Nov;14(11):1135-9
references.pmid: 2603046
references.citation: Spine (Phila Pa 1976). 1981 Jul-Aug;6(4):388-97
references.pmid: 7280828
references.citation: Invest Radiol. 1998 May;33(5):279-88
references.pmid: 9609487
references.citation: Spine (Phila Pa 1976). 2008 Nov 1;33(23):E870-6
references.pmid: 18978580
references.citation: Eur Spine J. 2007 Sep;16(9):1435-44
references.pmid: 17464516
references.citation: Clin Biomech (Bristol, Avon). 1999 Oct;14(8):515-21
references.pmid: 10521635
references.citation: Spine (Phila Pa 1976). 2006 Jan 15;31(2):E44-50
references.pmid: 16418624
references.citation: J Korean Med Sci. 2004 Feb;19(1):101-6
references.pmid: 14966350
references.citation: Biol Cybern. 2004 Jun;90(6):377-89
references.pmid: 15316785
references.citation: Clin Biomech (Bristol, Avon). 2002 Jun;17(5):361-7
references.pmid: 12084540
references.citation: Eur Spine J. 2005 Feb;14(1):27-35
references.pmid: 15723249
references.citation: J Biomech. 2007;40(11):2457-66
references.pmid: 17198708