Alejandro A Espinoza Orías1, Nicole M Mammoser2, John J Triano3, Howard S An4, Gunnar B J Andersson5, Nozomu Inoue6. 1. Assistant Professor, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL. 2. Research Assistant, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL. 3. Professor, Research Graduate Education and Research Program & Director, Partnerships and Research Commercialization, Canadian Memorial Chiropractic College, North York, ON, Canada. 4. The Morton International Professor, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL; Director of Spine Surgery and Spine Fellowship, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL. 5. The Ronald L. DeWald, M.D. Professor, Chairman Emeritus, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL. 6. Professor, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL. Electronic address: Nozomu_Inoue@rush.edu.
Abstract
OBJECTIVES: Axial rotation of the torso is commonly used during manipulation treatment of low back pain. Little is known about the effect of these positions on disc morphology. Rotation is a three-dimensional event that is inadequately represented with planar images in the clinic. True quantification of the intervertebral gap can be achieved with a disc height distribution. The objective of this study was to analyze disc height distribution patterns during torsion relevant to manipulation in vivo. METHODS: Eighty-one volunteers were computed tomography-scanned both in supine and in right 50° rotation positions. Virtual models of each intervertebral gap representing the disc were created with the inferior endplate of each "disc" set as the reference surface and separated into 5 anatomical zones: 4 peripheral and 1 central, corresponding to the footprint of the annulus fibrosus and nucleus pulposus, respectively. Whole-disc and individual anatomical zone disc height distributions were calculated in both positions and were compared against each other with analysis of variance, with significance set at P < .05. RESULTS: Mean neutral disc height was 7.32 mm (1.59 mm). With 50° rotation, a small but significant increase to 7.44 mm (1.52 mm) (P < .0002) was observed. The right side showed larger separation in most levels, except at L5/S1. The posterior and right zones increased in height upon axial rotation of the spine (P < .0001), whereas the left, anterior, and central decreased. CONCLUSIONS: This study quantified important tensile/compressive changes disc height during torsion. The implications of these mutually opposing changes on spinal manipulation are still unknown.
OBJECTIVES:Axial rotation of the torso is commonly used during manipulation treatment of low back pain. Little is known about the effect of these positions on disc morphology. Rotation is a three-dimensional event that is inadequately represented with planar images in the clinic. True quantification of the intervertebral gap can be achieved with a disc height distribution. The objective of this study was to analyze disc height distribution patterns during torsion relevant to manipulation in vivo. METHODS: Eighty-one volunteers were computed tomography-scanned both in supine and in right 50° rotation positions. Virtual models of each intervertebral gap representing the disc were created with the inferior endplate of each "disc" set as the reference surface and separated into 5 anatomical zones: 4 peripheral and 1 central, corresponding to the footprint of the annulus fibrosus and nucleus pulposus, respectively. Whole-disc and individual anatomical zone disc height distributions were calculated in both positions and were compared against each other with analysis of variance, with significance set at P < .05. RESULTS: Mean neutral disc height was 7.32 mm (1.59 mm). With 50° rotation, a small but significant increase to 7.44 mm (1.52 mm) (P < .0002) was observed. The right side showed larger separation in most levels, except at L5/S1. The posterior and right zones increased in height upon axial rotation of the spine (P < .0001), whereas the left, anterior, and central decreased. CONCLUSIONS: This study quantified important tensile/compressive changes disc height during torsion. The implications of these mutually opposing changes on spinal manipulation are still unknown.
Authors: Yoshihisa Otsuka; Howard S An; Ruth S Ochia; Gunnar B J Andersson; Alejandro A Espinoza Orías; Nozomu Inoue Journal: Spine (Phila Pa 1976) Date: 2010-04-15 Impact factor: 3.468
Authors: Gregory D Cramer; Jerrilyn Cambron; Joe A Cantu; Jennifer M Dexheimer; Judith D Pocius; Douglas Gregerson; Michael Fergus; Ray McKinnis; Thomas J Grieve Journal: J Manipulative Physiol Ther Date: 2013-05-03 Impact factor: 1.437
Authors: Shingo Miyazaki; Ashish D Diwan; Kenji Kato; Kevin Cheng; Won C Bae; Yang Sun; Junichi Yamada; Carol Muehleman; Mary E Lenz; Nozomu Inoue; Robert L Sah; Mamoru Kawakami; Koichi Masuda Journal: Eur Spine J Date: 2018-02-19 Impact factor: 3.134