Instrumented Pre-Hospital Care Simulation Mannequin for Use in Spinal Motion Restrictions Scenarios: Validation of Cervical and Lumbar Motion Assessment.

BACKGROUND: A mid-fidelity simulation mannequin, equipped with an instrumented cervical and lumbar spine, was developed to investigate best practices and train healthcare professionals in applying spinal motion restrictions (SMRs) during the early mobilization and transfer of accident victims with suspected spine injury. The study objectives are to (1) examine accuracy of the cervical and lumbar motions measured with the mannequin; and (2) confirm that the speed of motion has no bearing on this accuracy. METHODS: Accuracy was evaluated by concurrently comparing the orientation data obtained with the mannequin with that from an optoelectronic system. The mannequin's head and pelvis were moved in all anatomical planes of motion at different speeds. RESULTS: Accuracy, assessed by root-mean-square error, varied between 0.7° and 1.5° in all anatomical planes of motion. Bland-Altman analysis revealed a bias ranging from -0.7° to 0.6°, with the absolute limit of agreement remaining below 3.5°. The minimal detectable change varied between 1.3° and 2.6°. Motion speed demonstrated no impact on accuracy. CONCLUSIONS: The results of this validation study confirm the mannequin's potential to provide accurate measurements of cervical and lumbar motion during simulation scenarios for training and research on the application of SMR.

Wilderness Medical Society Clinical Practice Guidelines for Spinal Cord Protection: 2024 Update.

The Wilderness Medical Society reconvened an expert panel to update best practice guidelines for spinal cord protection during trauma management. This panel, with membership updated in 2023, was charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in wilderness environments. Recommendations are made regarding several parameters related to spinal cord protection. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks/burdens for each parameter according to American College of Chest Physicians methodology. Key recommendations include the concept that interventions should be goal-oriented (spinal cord/column protection in the context of overall patient and provider safety) rather than technique-oriented (immobilization). An evidence-based, goal-oriented approach excludes the immobilization of suspected spinal injuries via rigid collars or backboards.

Wearable Nanocomposite Sensor System for Motion Phenotyping Chronic Low Back Pain: A BACPAC Technology Research Site.

Chronic low back pain (cLBP) is a prevalent and multifactorial ailment. No single treatment has been shown to dramatically improve outcomes for all cLBP patients, and current techniques of linking a patient with their most effective treatment lack validation. It has long been recognized that spinal pathology alters motion. Therefore, one potential method to identify optimal treatments is to evaluate patient movement patterns (ie, motion-based phenotypes). Biomechanists, physical therapists, and surgeons each utilize a variety of tools and techniques to qualitatively assess movement as a critical element in their treatment paradigms. However, objectively characterizing and communicating this information is challenging due to the lack of economical, objective, and accurate clinical tools. In response to that need, we have developed a wearable array of nanocomposite stretch sensors that accurately capture the lumbar spinal kinematics, the SPINE Sense System. Data collected from this device are used to identify movement-based phenotypes and analyze correlations between spinal kinematics and patient-reported outcomes. The purpose of this paper is twofold: first, to describe the design and validity of the SPINE Sense System; and second, to describe the protocol and data analysis toward the application of this equipment to enhance understanding of the relationship between spinal movement patterns and patient metrics, which will facilitate the identification of optimal treatment paradigms for cLBP.

Cervical Spine Motion During Vehicle Extrication of Healthy Volunteers.

Objective: Prehospital spinal motion restriction as a prevention technique for secondary neurological injury is a key principle in emergency medicine. Our aim was to evaluate the effectiveness of different cervical spinal cord motion restriction techniques of awake and cooperative healthy volunteers during extrication.Methods: Twenty-three healthy volunteers were asked to exit a car (unassisted) with a rigid cervical collar (CC condition) or without it (autonomous exit: AE; instructed exit: IE); they were also extricated by two rescuers after setting a rigid cervical collar and by using an extrication device (CC + XT condition). Eight 3 D infrared cameras were calibrated around the vehicle to measure cervical spine angle, angular speed and acceleration in the sagittal plane. Surface wireless EMG electrodes were used to record superior trapezius, erector spinae and rectus abdominis muscle activity. All measures were recorded during two phases: device positioning (maneuver) and vehicle exiting.Results: The lowest range of motion was observed in CC during maneuver and exit (about 17°), the greatest in AE and IE (about 45°); when the extrication device was utilized along with the cervical collar (CC + XT) an increase, rather than a further decrease, in the range of motion was observed (about 25° during maneuver and exit). Larger values of angular speed and acceleration were observed in CC + XT when compared to CC, both during maneuver and exit (p < 0.001). The lowest EMG activity was observed during maneuver in CC and CC + XT; during exit a lower EMG activity was observed in CC + XT compared to CC (p < 0.001). Thus, when an extrication device is utilized (CC + XT), a lower active control of the cervical spine region is associated with faster and more brisk movements of the cervical spine compared to CC alone.Conclusions: Our findings support the idea that spinal motion restriction via rigid cervical collar of awake and cooperative trauma patients is effective in reducing cervical spine motion in the sagittal plane during vehicle extrication.

Prehospital Protocols Reducing Long Spinal Board Use Are Not Associated with a Change in Incidence of Spinal Cord Injury.

Introduction: Many emergency medical services (EMS) agencies have de-emphasized or eliminated the use of long spinal boards (LSB) for patients with possible spinal injury. We sought to determine if implementation of spinal motion restriction (SMR) protocols, which reduce LSB use, was associated with an increase in spinal cord injury (SCI). Methods: This retrospective observational study includes EMS encounters from January 1, 2013 to December 31, 2015 submitted by SMR-adopting ground-based agencies to a state EMS database with hospital discharge data. Encounters were excluded if SMR implementation date was unknown, occurred during a 3-month run-in period, or were duplicates. Study samples include patients with traumatic injury (TI), possible spinal trauma (P-ST), and verified spinal trauma (V-ST) using hospital discharge ICD-9/10 diagnosis codes. The incidence of SCI before and after implementation of SMR was compared using Chi-squared and logistic regression. Results: From 1,005,978 linked encounters, 104,315 unique encounters with traumatic injury and known SMR implementation date were identified with 51,199 cases of P-ST and 5,178 V-ST cases. The incidence of SCI in the pre-SMR and post-SMR interval for each group was: TI, 0.20% vs. 0.22% (p = 0.390); P-ST, 0.40% vs. 0.45% (p = 0.436); and V-ST, 4.04% vs. 4.37% (p = 0.561). Age and injury severity adjusted odds ratio of SCI in the highest risk cohort of patients with V-ST was 1.097 after SMR implementation (95% CI 0.818-1.472). Conclusion: In this limited study, no change in the incidence of SCI was identified following implementation of SMR protocols. Prospective evaluation of this question is necessary to evaluate the safety of SMR protocols.

Improvised vs Standard Cervical Collar to Restrict Spine Movement in the Backcountry Environment.

INTRODUCTION: To compare the effectiveness of a molded fleece jacket with that of a standard cervical collar at limiting movement of the cervical spine in 3 different directions. METHODS: This is a prospective study using 24 healthy volunteers to measure cervical flexion/extension, rotation, and lateral flexion with both the fleece collar and the standard cervical collar. A hand-held goniometer was used for measurements. The results were then analyzed for the 3 independent movements using a noninferiority test. RESULTS: The fleece collar was determined to be noninferior at limiting the designated motions. Comfort was greater while wearing the improvised fleece collar. CONCLUSIONS: Our small study demonstrated that mountain travelers and rescuers may be able to use an improvised fleece jacket collar in place of a standard collar if spine trauma is suspected after a backcountry accident. Further research should examine different types of improvised collars, their ability to remain in place over extended evacuations, and when to apply collars to backcountry patients.

Wilderness Medical Society Clinical Practice Guidelines for Spinal Cord Protection.

The Wilderness Medical Society reconvened an expert panel to update best practice guidelines for spinal cord protection during trauma management. This panel, with membership updated in 2018, was charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in wilderness environments. Recommendations are made regarding several parameters related to spinal cord protection. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks/burdens for each parameter according to the methodology stipulated by the American College of Chest Physicians. Key recommendations include the concept that interventions should be goal oriented (spinal cord/column protection in the context of overall patient and provider safety) rather than technique oriented (immobilization). This evidence-based, goal-oriented approach does not support the immobilization of suspected spinal injuries via rigid collars or backboards.

Validation of a field spinal motion restriction protocol in a level I trauma center.

BACKGROUND: Spinal motion restriction (SMR) after traumatic injury has been a mainstay of prehospital trauma care for more than 3 decades. Recent guidelines recommend a selective approach with cervical spine clearance in the field when criteria are met. MATERIALS AND METHODS: In January 2014, the Department of Health Services of the City of Los Angeles, California, implemented revised guidelines for cervical SMR after blunt mechanism trauma. Adult patients (aged ≥18 y) with an initial Glasgow Coma Scale (GCS) score of ≥13 presented to a single level I trauma center after blunt mechanism trauma over the following 1-y period were retrospectively reviewed. Demographics, injury data, and prehospital data were collected. Cervical spine injury (CSI) was identified by International Classification of Disease, Ninth Revision, codes. RESULTS: Emergency medical services transported 1111 patients to the emergency department who sustained blunt trauma. Patients were excluded if they refused c-collar placement or if documentation was incomplete. A total of 997 patients were included in our analysis with 172 (17.2%) who were selective cleared of SMR per protocol. The rate of Spinal Cord Injury was 2.2% (22/997) overall and 1.2% (2/172) in patients without SMR. The sensitivity and specificity of the protocol are 90.9% (95% confidence interval: 69.4-98.4) and 17.4% (95% confidence interval: 15.1-20.0), respectively, for CSI. Patients with CSI who arrived without immobilization having met field clearance guidelines, were managed without intervention, and had no neurologic compromise. CONCLUSIONS: Guidelines for cervical SMR have high sensitivity and low specificity to identify CSI. When patients with injuries were not placed on motion restrictions, there were no negative clinical outcomes.

Quantifying the Risk of Spinal Injury in Motor Vehicle Collisions According to Ambulatory Status: A Prospective Analytical Study.

BACKGROUND: The association between ambulation at the scene of a motor vehicle collision (MVC) and spinal injury has never been quantified. OBJECTIVE: To evaluate the association between ambulation and spinal injury in patients involved in a MVC. METHODS: Prospective analytical-observational cohort study. Inclusion: patients sustaining traumatic injury in a MVC. Exclusion: < 18 years old, pregnancy. PRIMARY OUTCOME: spinal injury defined as injury to the cervical, thoracic, or lumbar spinal cord, bones, or ligaments. Secondary outcome: Injury resulting in neurological deficit, need for surgery, or death. A generalized linear model was used to evaluate the association between outcome and predictor variables. Risk ratios [RR] were reported with a point estimate and 95% confidence interval (CI). A two-tailed alpha of < 0.05 was the threshold for statistical significance. RESULTS: There were 704 patients analyzed. Nonambulatory patients were 2.29 times more likely to sustain a spinal injury, compared to ambulatory patients (RR 2.29, 95% CI 1.34-3.91). Patients ≥ 65 years of age were 3.27 times more likely to sustain a spinal injury (RR 3.27, 95% CI 1.66-6.45). Patients with a Glasgow Coma Scale score ≤ 8 were 4.93 times more likely to sustain a spinal injury (RR 4.93, 95% CI 1.86-13.10). CONCLUSION: In this prospective analytical-observational study evaluating the association between ambulatory status and spinal injury in patients involved in MVCs, we observed that those patients who were nonambulatory were more than two times as likely to have a spinal injury compared to those patients who were ambulatory at the scene.

A kinematic analysis of the lower limb with regard to restricted spinal motion during gait.

[Purpose] The purpose of this study was to investigate the effect of restricted spinal motion on kinematic changes in the lower extremities using a rigid thoracolumbosacral orthosis. [Subjects and Methods] Forty healthy males in their 20s were selected as the sample, which was randomly and evenly divided into two groups: (1) the WT group (with a thoracolumbosacral orthosis) and (2) the WOT group (without a thoracolumbosacral orthosis). The spinal orthosis used in this study was a thoracolumbosacral orthosis called a plastic body jacket. [Results] The sagittal plane; in the level ground walking measurements, significance differences were found at the H2 (Hip maximum flexion/extension in midstance phase) and K2 (Knee maximum flexion/extension in midstance phase) between the WT group and the WOT group. [Conclusion] It can be concluded that a spinal orthosis is useful in stabilizing the lower extremities during stair gaiting, and that appropriate application of the orthosis plays a supporting role in the activities of daily life and therapeutic intervention.

Effects of abdominal hollowing and bracing on each intervertebral angle during quadruped upper and lower extremity lift: Three-dimensional motion analysis of the spine.

To investigate the effects of intentionally minimizing spinal motion and abdominal muscle contractions on intervertebral angles during quadruped upper and lower extremity lift (QULEL). Fifteen healthy men performed the QULEL under four conditions: without any special instructions (basic), with the intention to minimize spinal motion (intentional), with abdominal bracing (bracing), and with abdominal hollowing (hollowing). Each intervertebral angle was calculated from the local coordinate system using the marker data obtained from a motion capture system. Shear moduli, as indicators of the activities of the right transversus abdominis (TrA), internal and external oblique, and rectus abdominis muscles, were assessed using shear wave elastography during QULEL. One-way repeated-measures analysis of variance and multiple comparisons among conditions were used to compare each shear modulus of the abdominal muscle and the changes in thoracic kyphosis (Th1-12), lumbar lordosis (L1-5), and lumbar intervertebral angles from the quadruped position to QULEL. The significance level was set at P < 0.05. Changes in lumbar lordosis and L2/L3 and L3/L4 extension angles were significantly lower under hollowing than under other conditions (effect size ηG2: lumbar lordosis, 0.068; L2/L3, 0.072; L3/L4, 0.043). The change in the L1/L2 extension angle significantly decreased in bracing and hollowing compared with the basic (ηG2 = 0.070). Only the TrA shear modulus significantly increased in bracing and hollowing compared with the basic (ηG2 = 0.146). Abdominal hollowing during the QULEL increased TrA activity and suppressed lumbar extension, except at L4/L5, and may be more effective as a rehabilitation exercise for controlling spinal motion.

Analysis of spine motion during prehospital extrication procedures in motorsport.

PURPOSE: The appropriate extrication techniques for trauma patients after car accidents remain a topic of controversy. Various techniques for immobilizing the cervical spine during prehospital extrication have been investigated. METHODS: This explorative study compared the amount of spinal motion during five different extrication procedures from a racecar and a rallycar performed by two teams: a professional motorsport extrication team and a team of professional emergency medical technicians (EMTs). Two different microelectromechanical systems were used to measure spinal motion, and a motionscore was calculated to compare the amount of remaining spinal motion. A high motionscore indicates high remaining motion and a low motionscore indicates low remaining motion. RESULTS: The use of an extricable seat results in a mean overall motion score of 1617 [95% CI 308-2926]. Emergency extrication without equipment resulted in the lowest overall motionscore 1448 [95% CI 1070-1826]. In case of urgent extrication the Extrication team attained a motionscore of 2118 [95% CI 517-3718] and the EMT team a motionscore of 2932 [95% CI 1427-4435]. When performing the procedure with the aid of a rescue boa, the EMT team achieved an overall mean motionscore in the same range 2725 [95% CI 568-4881] with boa vs. 2932 [95% CI 1427-4435] without boa. When mean scores of individual spinal segments were analyzed, we found that the EMT team did especially worse in immobilizing the cervical spine 198 vs. 758. CONCLUSIONS: Regular training of extrication procedures has paid off considerably in reducing spinal movement during extrication from a racecar. If an extricable seat is available, extrication should be performed using it. However, if emergency extrication is necessary, an additional manual cervical spine immobilization should be conducted using the Rautek maneuver to sufficiently reduce cervical spine movement.

Relationship between facet joint osteoarthritis and lumbar paraspinal muscle atrophy: a cross-sectional study.

OBJECTIVE: The paraspinal muscles play an essential role in the stabilization of the lumbar spine. Lumbar paraspinal muscle atrophy has been linked to chronic back pain and degenerative processes within the spinal motion segment. However, the relationship between the different paraspinal muscle groups and facet joint osteoarthritis (FJOA) has not been fully explored. METHODS: In this cross-sectional study, the authors analyzed adult patients who underwent lumbar spinal surgery between December 2014 and March 2023 for degenerative spinal conditions and had preoperative MRI and CT scans. The fatty infiltration (FI) and functional cross-sectional area (fCSA) of the psoas, erector spinae, and multifidus muscles were assessed on axial T2-weighted MR images at the level of the upper endplate of L4 based on established studies and calculated using custom-made software. Intervertebral disc degeneration at each lumbar level was evaluated using the Pfirrmann grading system. The grades from each level were summed to report the cumulative lumbar Pfirrmann grade. Weishaupt classification (0-3) was used to assess FJOA at all lumbar levels (L1 to S1) on preoperative CT scans. The total lumbar FJOA score was determined by adding the Weishaupt grades of both sides at all 5 levels. Correlation and linear regression analyses were conducted to assess the relationship between FJOA and paraspinal muscle parameters. RESULTS: A total of 225 patients (49.7% female) with a median age of 61 (IQR 54-70) years and a median BMI of 28.3 (IQR 25.1-33.1) kg/m2 were included. After adjustment for age, sex, BMI, and the cumulative lumbar Pfirrmann grade, only multifidus muscle fCSA (estimate -4.69, 95% CI -6.91 to -2.46; p < 0.001) and FI (estimate 0.64, 95% CI 0.33-0.94; p < 0.001) were independently predicted by the total FJOA score. A similar relation was seen with individual Weishaupt grades of each lumbar level after controlling for age, sex, BMI, and the Pfirrmann grade of the corresponding level. CONCLUSIONS: Atrophy of the multifidus muscle is significantly associated with FJOA in the lumbar spine. The absence of such correlation for the erector spinae and psoas muscles highlights the unique link between multifidus muscle quality and the degeneration of the spinal motion segment. Further research is necessary to establish the causal link and the clinical implications of these findings.

Traditional Spinal Immobilization versus Spinal Motion Restriction in Cervical Spine Movement; a Randomized Crossover Trial.

Introduction: Proper cervical spine immobilization is essential to prevent further injury following trauma. This study aimed to compare the cervical range of motion (ROM) and the immobilization time between traditional spinal immobilization (TSI) and spinal motion restriction (SMR). Methods: This study was a randomized 2x2 crossover design in healthy volunteers. Participants were randomly assigned by Sequential numbered, opaque, sealed envelopes (SNOSE) with permuted block-of-four randomization to TSI or SMR. We used an inertial measurement unit (IMU) sensor to measure the cervical ROM in three dimensions focusing on flexion-extension, rotation, and lateral bending. The immobilization time was recorded by the investigator. Results: A total of 35 healthy volunteers were enrolled in the study. The SMR method had cervical spine movement lower than the TSI method about 3.18 degrees on ROM in flexion-extension (p < 0.001). The SMR method had cervical spine movement lower than the TSI method about 2.01 degrees on ROM in lateral bending (p = 0.022). The immobilization time for the SMR method was 11.88 seconds longer than for the TSI method (p < 0.001) but not clinically significant. Conclusion: SMR that used scoop stretcher resulted in significantly less cervical spine movement than immobilization with a TSI that used long spinal board. We recommend implementing the SMR protocol for transporting trauma patients, as minimizing cervical motion may enhance patient outcomes.

The science of spinal motion palpation: a review and update with implications for assessment and intervention.

Spinal motion palpation (SMP) is a standard component of a manual therapy examination despite questionable reliability. The present research is inconclusive as to the relevance of the findings from SMP, with respect to the patient's pain complaints. Differences in the testing methods and interpretation of spinal mobility testing are problematic. If SMP is to be a meaningful component of a spinal examination, the methods for testing and interpretation must be carefully scrutinized. The intent of this narrative review is to facilitate a better understanding of how SMP should provide the examiner with relevant information for assessment and treatment of patients with spinal pain disorders. The concept of just noticeable difference is presented and applied to SMP as a suggestion for determining the neutral zone behavior of a spinal segment. In addition, the use of a lighter, or more passive receptive palpation technique, is considered as a means for increasing tactile discrimination of spinal movement behavior. Further understanding of the scientific basis of testing SMP may improve intra- and inter-examiner reliability. The significance of the findings from SMP should be considered in context of the patient's functional problem. Methodological changes may be indicated for the performance of SMP techniques, such as central posterior-anterior (PA) pressure and passive intervertebral motion tests, in order to improve reliability. Instructors of manual therapy involved in teaching SMP should be knowledgeable of the neurophysiological processes of touch sensation so as to best advise students in the application of the various testing techniques.

Acute and Emergent Spinal Injury Assessment and Treatment.

Sports participation is a leading cause of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. Planning the process of transport for home venues before the start of the season and ensuring that a medical time out occurs at home and away games can reduce complications of transport decisions on the field of play and expedite transport of the spine-injured athlete.

Intubation during spinal motion restriction using the LuboTM cervical collar - a manikin simulation study.

Introduction: The LuboTM collar is a cervical motion restriction device featuring a unique external jaw-thrust mechanism designed to provide non-invasive airway patency. In addition, tracheal intubation is facilitated by releasing an anterior chin strap; this allows better mouth opening than the previous generation of semi-rigid cervical collars. This study aimed to compare tracheal intubation using the LuboTM collar combined with manual in-line stabilization (MILS) to intubation with MILS alone. The primary outcome was the time to successful intubation. Secondary outcomes compared intubation success rate, Cormack-Lehane grade, ease of intubation and dental trauma. Methods: A randomized, cross-over, equivalence study was performed. Eighty full-time physician anaesthesia providers were recruited. Participants performed tracheal intubation using direct laryngoscopy on a manikin under two different scenarios: with the LuboTM collar and MILS applied, and with MILS and no cervical collar. The time to successful intubation was measured and compared using two-one-sided and paired t-tests. Results: Intubation times fell well within the a priori equivalence limits of 10 seconds, with a mean difference (95% CI) of 0.52 seconds (-1.30 to 2.56). There was no significant difference in intubation time with the LuboTM collar (mean [SD] 19.2 [4.5] seconds) compared to the MILS alone group (19.7 [5.2] seconds). The overall success rate was 98.7% in the Lubo group and 100% in the MILS group. Adequate laryngoscopy views (Cormack-Lehane grades I to IIb) were equivalent between groups (Lubo 92.5% versus MILS alone 93.7%). Conclusion: In this manikin-based study, the time to intubation with the LuboTM collar and MILS applied was equivalent to time to intubation with MILS alone, with similar intubating conditions. Thus, the LuboTM collar and MILS may simplify airway management by reducing the number of steps required to perform intubation in patients requiring cervical motion restriction.

Factors which affect the application and implementation of a spinal motion restriction protocol by prehospital providers in a low resource setting: A scoping review.

Introduction: The safety and effectiveness of prehospital clinical c-spine clearance or spinal motion restriction (SMR) decision support tools are unclear. The present study aimed to examine the available literature on clinical cervical spine clearance and selective SMR decision support tools to identify possible barriers to implementation, safety, and effectiveness when used by emergency medical service (EMS) practitioners. Method: We performed a focused scoping review of published literature on the prehospital use of clinical c-spine clearance and SMR decision tools in adult blunt trauma patients. The Medline, Embase, Cochrane Library, Cumulative Index of Nursing and Allied Health Literature, Web of Science, Turning Research into Practice and EBSCOhost online databases were searched (February 2021). The type of decision support tool and facilitators and barriers to its use were extracted from each included publication in accordance with a modified descriptive-analytical framework. Extracted data were subjected to thematic analysis. Results: Following screening, forty-two articles were included in this scoping review. No studies conducted specifically in low resource settings were found. The majority of articles (57%) evaluated the use of specific SMR decision support tools, such as the National Emergency X-Radiography Utilization Study (NEXUS) and the Canadian C-spine Rule (CCR). Potential facilitators of safe and effective use were identified in 60%, and potential barriers to safe and effective use in 55% of included articles. Only one study evaluated the CCR when used by EMS practitioners, making it difficult to determine its appropriateness for implementation in the prehospital setting. Conclusion: This is the first scoping review, to our knowledge, that has attempted to identify the possible barriers and facilitators to their implementation, safety, and effectiveness when used by EMS practitioners. Key issues identified included terminology, guideline compliance and implementation, and a lack of context-specific evidence. These may provide important considerations for future guideline development.

What is the most appropriate method for the measurement of the range of motion in the lumbar spine and how does surgical fixation affect the range of movement of the lumbar spine in adolescent idiopathic scoliosis? A systematic review protocol.

INTRODUCTION: Adolescent idiopathic scoliosis (AIS) is a three-dimensional rotational change in the normal shape of the spine which affects children aged 10 to 18 years. Both the condition and its management can have significant impact on functional ability. Currently, expected restriction in spinal motion is experience based, rather than evidence based, and discussions to inform patient expectations pre-operatively can be difficult. The aim of this review is to evaluate the evidence pertaining to measurement of spinal motion and whether this is altered following surgery, dependent on the anatomical level of surgical fixation in AIS.  METHODS/ANALYSIS: This protocol is reported in line with both PRISMA-P and informed by the COSMIN methodology. Electronic databases will be searched using a two-stage search strategy. The first stage will identify and evaluate the methods used to assess spinal motion. The second stage aims to evaluate the change in spinal motion using these methods based on anatomical level of fixation following surgery along with the measurement properties of those methods, to include the validity, reliability and responsiveness of the methods. Two reviewers will independently screen the search results against eligibility criteria, extract the data and assess the quality of the included studies. Any disputes between the reviewers will be resolved with a third independent reviewer. Data may be pooled where possible; however, this is not expected. The overall strength of the body of evidence will then be assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. PATIENT AND PUBLIC INVOLVEMENT: Patients and members of the public will not be consulted in the production of this review, although the review was conceived based on the experiences of the authors when managing this patient population and a need to address patient expectations in pre-operative planning. ETHICS, DISSEMINATION AND DATA AVAILABILITY: No ethical approval required. The final review will be submitted to peer-reviewed journals for publication and disseminated publicly. The datasets used and/or analysed in this review will be available from the corresponding author on reasonable request.  SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number. CRD42021282264.

Motion characteristics of the lower lumbar spine in individuals with different pelvic incidence: An in vivo biomechanical study.

BACKGROUND: Pelvic incidence is the quantification of the pelvis anatomical shape which has significant effect on the occurrence of various lumbar degenerative diseases. The aim of this study was to measure the in vivo dynamic motion characteristics of the lower lumbar spine in people with different pelvic incidence. METHODS: A total of 55 volunteers were included in the study. The participants were devided into 3 groups (A: pelvic incidence≤40°, B: 40° < pelvic incidence <60° and C: pelvic incidence ≥60°). The L3-S1 vertebrae of each subject was MRI scanned to construct 3D models. The lumbar spine was then imaged using a dual fluoroscopic imaging system as the subject performed physiological position. The 3D vertebral models and the fluoroscopic images were used to reproduce the in vivo vertebral positions along the motion path. The relative translations and rotations of each motion segment were analyzed. FINDINGS: At the L5-S1 segment, the primary ranges of motion for left-right axial rotation and flexion-extension of the patients with large pelvic incidence (3.28° ± 0.79°, 7.56° ± 1.81°) were significantly larger than normal pelvic incidence (2.61° ± 1.01°, 6.57° ± 2.18°) and small pelvic incidence (2.00° ± 0.60°, 5.83° ± 1.67°). INTERPRETATION: The anatomic variable pelvic incidence is associated with the ranges of motion in lower lumbar vertebrae, especially in the L4-5 and L5-S1 segments.