The global end-ranges of neck flexion and extension do not represent the maximum rotational ranges of the cervical intervertebral joints in healthy adults - an observational study

Victoria Andersen*, Xu Wang, Mark de Zee, Lasse Riis Østergaard, Maciej Plocharski, René Lindstroem

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

1 Citation (Scopus)
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Abstract

Background
In clinical diagnosis, the maximum motion of a cervical joint is thought to be found at the joint’s end-range and it is this perception that forms the basis for the interpretation of flexion/extension imaging studies.

There have however, been representative cases of joints producing their maximum motion before end-range, but this phenomenon is yet to be quantified.

Purpose
To provide a quantitative assessment of the difference between maximum joint motion and joint end-range in healthy subjects. Secondarily to classify joints into type based on their motion and to assess the proportions of these joint types.

Study design
This is an observational study.

Subject sample
Thirty-three healthy subjects participated in the study.

Outcome measures
Maximum motion, end-range motion and surplus motion (the difference between maximum motion and end-range) in degrees were extracted from each cervical joint.

Methods
Thirty-three subjects performed one flexion and one extension motion excursion under video fluoroscopy. The motion excursions were divided into 10% epochs, from which maximum motion, end-range and surplus motion were extracted. Surplus motion was then assessed in quartiles and joints were classified into type according to end-range.

Results
For flexion 48.9% and for extension 47.2% of joints produced maximum motion before joint end-range (type S). For flexion 45.9% and for extension 46.8% of joints produced maximum motion at joint end-range (type C). For flexion 5.2% of joints and for extension 6.1% of joints concluded their motion anti-directionally (type A).

Significant differences were found for C2/C3 (P = 0.000), C3/C4 (P = 0.001) and C4/C5 (P = 0.005) in flexion and C1/C2 (P = 0.004), C3/C4 (P = 0.013) and C6/C7 (P = 0.013) in extension when comparing the joint end- range of type C and type S.

The average pro-directional (motion in the direction of neck motion) surplus motion was 2.41° ± 2.12° with a range of (0.07° -14.23°) for flexion and 2.02° ± 1.70° with a range of (0.04°-6.97°) for extension.

Conclusion
This is the first study to categorise joints by type of motion. It cannot be assumed that end-range is a demonstration of a joint’s maximum motion, as type S constituted approximately half of the joints analysed in this study.
Original languageEnglish
Article number18
JournalChiropractic & Manual Therapies
Volume29
Issue number1
ISSN2045-709X
DOIs
Publication statusPublished - 25 May 2021

Keywords

  • Cervical vertebrae
  • Fluoroscopy
  • Maximum motion
  • Neck
  • Range of motion

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