Axial rotation and lateral bending in the normal lumbar spine measured by three-dimensional radiography.

A three-dimensional radiographic technique was used to investigate the ranges of active axial rotation and lateral bending plus the accompanying rotations in the planes other than that of the primary voluntary movements in two groups of normal male volunteers. There was approximately 2 degrees of axial rotation at each intervertebral joint with L3-4 and L4-5 being slightly more mobile. Lateral bending of approximately 10 degrees occurred at the upper three levels, while there was significantly less movement of 6 degrees and 3 degrees at L4-5 and L5-S1, respectively. In the upper lumbar spine, axial rotation to the right was accompanied by lateral bending to the left and vice versa. At L5-S1, axial rotation and lateral bending generally accompanied each other in the same direction, while L4-5 was a transitional level. These measurements in vivo demonstrated that there was no simple mechanical coupling of the rotations, and that the lordotic shape of the lumbar spine together with muscular control are probably the two principal factors determining the relation between the primary and accompanying rotations.