In Vivo Cervical Spine Kinematics, Arthrokinematics and Disc Loading in Asymptomatic Control Subjects and Anterior Fusion Patients

Approximately 25% of cervical arthrodesis patients require reoperation within 10 years of the initial surgery due to degeneration of motion segments adjacent to the arthrodesis. Adjacent segment degeneration is believed to result from one or more of the following distinct causes: 1) the natural history of the adjacent disc; 2) biomechanical stress on the adjacent level following the fusion; and 3) disruption of the adjacent segment anatomy due to the initial surgery. The overarching hypothesis of this study is that, after fusion, mechanical factors initiate disc degeneration by exposing the disc tissue to novel, excessive loads. The aims of this study were to identify kinematic and arthrokinematic characteristics of cervical spine motion that differentiate asymptomatic subjects from single-level anterior fusion patients during in vivo functional loading, and to verify and validate a single-level, subject-specific finite element model of the sub-axial cervical spine. Twenty asymptomatic control subjects and 17 single-level ACDF patients of similar age performed dynamic flexion-extension of the cervical spine while biplane radiographs were collected at 30 images per second. A previously validated volumetric modelbased tracking process matched subject-specific vertebral bone models to each pair of radiographs with sub-millimeter accuracy. Adjacent segment kinematics (total range of motion, contributions to motion, path of the center of rotation) were not significantly different between fusion and control groups. Adjacent segment arthrokinematics (disc and facet joint capsule deformation) were significantly different between groups. Inverse dynamics and finite element computational models indicated that, relative to the static neutral position, the force applied to the C56 motion segment increased by five times head weight during full extension.

This study has identified differences in the mechanics of adjacent segments during dynamic functional loading. The results suggest that in order to evaluate the effects of fusion on adjacent segments, from a mechanical perspective and clinical perspective, it may be most beneficial to assess arthrokinematic factors such as disc deformation and facet joint capsule deformation, rather than more traditional kinematic parameters such as range of motion and center of rotation.

Year	Entry
1999	Kumaresan S, Yoganandan N, Pintar FA. Finite element analysis of the cervical spine: a material property sensitivity study. Clin Biomech (Bristol, Avon). January 1999;12(1):41-53.
2009	Panzer MB, Cronin DS. C4–C5 segment finite element model development, validation, and load-sharing investigation. J Biomech. March 11, 2009;42(4):480-490.
2007	Anderson AE, Ellis BJ, Weiss JA. Verification, validation and sensitivity studies in computational biomechanics. Comput Methods Biomech Biomed Eng. June 2007;10(3):171-184.
1987	Stokes IAF. Surface strain on human intervertebral discs. J Orthop Res. 1987;5(3):348-355.
1977	Urban JPG, Holm S, Maroudas A, Nachemson A. Nutrition of the intervertebral disk: an in vivo study of solute transport. Clin Orthop Relat Res. November 1977;129:101-114.
1981	Nachemson AL. Disc pressure measurements. Spine. January–February 1981;6(1):93-97.
2008	Jones AC, Wilcox RK. Finite element analysis of the spine: towards a framework of verification, validation and sensitivity analysis. Med Eng Phys. December 2008;30(10):1287-1304.
2000	Bogduk N, Mercer S. Biomechanics of the cervical spine, I: normal kinematics. Clin Biomech (Bristol, Avon). November 2000;15(9):633-648.
2002	Nightingale RW, Winkelstein BA, Knaub KE, Richardson WJ, Luck JF, Myers BS. Comparative strengths and structural properties of the upper and lower cervical spine in flexion and extension. J Biomech. June 2002;35(6):725-732.
1964	Fielding JW. Normal and selected abnormal motion of the cervical spine from the second cervical vertebra to the seventh cervical vertebra based on cineroentgenography. J Bone Joint Surg. December 1964;46A(8):1779-1781.
2004	Pearson AM, Ivancic PC, Ito S, Panjabi MM. Facet joint kinematics and injury mechanisms during simulated whiplash. Spine. February 15, 2004;29(4):390-397.
1996	Lord SM, Barnsley L, Wallis BJ, Bogduk N. Chronic cervical zygapophysial joint pain after whiplash: a placebo-controlled prevalence study. Spine. August 1996;21(15):1737-1744.
2004	Oi N, Pandy MG, Myers BS, Nightingale RW, Chancey VC. Variation of neck muscle strength along the human cervical spine. Stapp Car Crash J. 2004;48:397-417. SAE 2004-22-0017.
1999	Patwardhan AG, Havey RM, Meade KP, Lee B, Dunlap B. A follower load increases the load-carrying capacity of the lumbar spine in compression. Spine. May 15, 1999;24(10):1003-1009.
2011	Curatolo M, Bogduk N, Ivancic PC, McLean SA, Siegmund GP, Winkelstein BA. The role of tissue damage in whiplash-associated disorders: discussion paper 1. Spine. December 2011;36(suppl 25S):S309-S315.
1975	White AA III, Johnson RM, Panjabi MM, Southwick WO. Biomechanical analysis of clinical stability in the cervical spine. Clin Orthop Relat Res. June 1975;109:85-96.
2005	Iatridis JC, MacLean JJ, Ryan DA. Mechanical damage to the intervertebral disc annulus fibrosus subjected to tensile loading. J Biomech. March 2005;38(3):557-565.
1999	Wilke H-J, Neef P, Caimi M, Hoogland T, Claes LE. New in vivo measurements of pressures in the intervertebral disc in daily life. Spine. April 15, 1999;24(8):755-762.
1988	Bogduk N, Marsland A. The cervical zygapophysial joints as a source of neck pain. Spine. June 1988;13(6):610-617.
2000	Patwardhan AG, Havey RM, Ghanayem AJ, Diener H, Meade KP, Dunlap B, Hodges SD. Load-carrying capacity of the human cervical spine in compression is increased under a follower load. Spine. June 15, 2000;25(12):1548-1554.
2001	Panjabi MM, Crisco JJ, Vasavada A, Oda T, Cholewicki J, Nibu K, Shin E. Mechanical properties of the human cervical spine as shown by three-dimensional load-displacement curves. Spine. December 2001;26(24):2692-2700.
2004	Brolin K, Halldin P. Development of a finite element model of the upper cervical spine and a parameter study of ligament characteristics. Spine. February 15, 2004;29(4):376-385.
2012	Seacrist T, Arbogast KB, Maltese MR, García-Espaňa JF, Lopez-Valdes FJ, Kent RW, Tanji H, Higuchi K, Balasubramanian S. Kinetics of the cervical spine in pediatric and adult volunteers during low speed frontal impacts. J Biomech. January 3, 2012;45(1):99-106.
1991	Dvorak J, Panjabi MM, Novotny JE, Antinnes JA. In vivo flexion/extension of the normal cervical spine. J Orthop Res. November 1991;9(6):828-834.
2003	Chancey VC, Nightingale RW, Van Ee CA, Knaub KE, Myers BS. Improved estimation of human neck tensile tolerance: reducing the range of reported tolerance using anthropometrically correct muscles and optimized physiologic initial conditions. Stapp Car Crash J. 2003;47:135-153. SAE 2003-22-0008.
2000	Yoganandan N, Kumaresan S, Pintar FA. Geometric and mechanical properties of human cervical spine ligaments. J Biomech Eng. December 2000;122(6):623-629.
1986	Pooni JS, Hukins DWL, Harris PF, Hilton RC, Davies KE. Comparison of the structure of human intervertebral discs in the cervical, thoracic and lumbar regions of the spine. Surg Radiol Anat. September 1986;8(3):175-182.
2002	Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, Whittle M, D'Lima DD, Cristofolini L, Witte H, Schmid O, Stokes I. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion, I: ankle, hip, and spine. J Biomech. 2002;35(4):543-548.
1995	Barnsley L, Lord SM, Wallis BJ, Bogduk N. The prevalence of chronic cervical zygapophysial joint pain after whiplash. Spine. January 1995;20(1):20-25.
2004	Walsh AJL, Lotz JC. Biological response of the intervertebral disc to dynamic loading. J Biomech. March 2004;37(3):329-337.
2001	Yoganandan N, Kumaresan S, Pintar FA. Biomechanics of the cervical spine, II: cervical spine soft tissue responses and biomechanical modeling. Clin Biomech (Bristol, Avon). January 2001;16(1):1-27.
2009	Winter DA. Biomechanics and Motor Control of Human Movement. 4th ed. Hoboken, NJ: Inc, John Wiley & Sons; 2009.
1995	Stokes IAF, Gardner-Morse M. Lumbar spine maximum efforts and muscle recruitment patterns predicted by a model with multijoint muscles and joints with stiffness. J Biomech. February 1995;28(2):173-186.
1980	Spoor CW, Veldpaus FE. Rigid body motion calculated from spatial co-ordinates of markers. J Biomech. 1980;13(4):391-393.
2009	Yoganandan N, Pintar FA, Zhang J, Baisden JL. Physical properties of the human head: mass, center of gravity and moment of inertia. J Biomech. June 19, 2009;42(9):1177-1192.
2005	Pintar FA, Yoganandan N, Baisden J. Characterizing occipital condyle loads under high-speed head rotation. Stapp Car Crash J. 2005;49:33-47. SAE 2005-22-0002.
1995	Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc B. 1995;57(1):289-300.
1991	Panjabi MM, Oxland TR, Parks EH. Quantitative anatomy of cervical spine ligaments, II: middle and lower cervical spine. J Spinal Disord. September 1991;4(3):277-285.
2012	Mattucci SFE, Moulton JA, Chandrashekar N, Cronin DS. Strain rate dependent properties of younger human cervical spine ligaments. J Mech Behav Biomed Mater. June 2012;10:216-226.
1989	Lind B, Sihlbom H, Nordwall A, Malchau H. Normal range of motion of the cervical spine. Arch Phys Med Rehabil. September 1989;70(9):692-695.
2010	Pintar FA, Yoganandan N, Maiman DJ. Lower cervical spine loading in frontal sled tests using inverse dynamics: potential applications for lower neck injury criteria. Stapp Car Crash J. 2010;54:133-166. SAE 2010-22-0008.
1984	Nissan M, Gilad I. The cervical and lumbar vertebrae: an anthropometric model. Eng Med. July 1984;13(3):111-114.
1988	Moroney SP, Schultz AB, Miller JAA. Analysis and measurement of neck loads. J Orthop Res. September 1988;6(5):713-720.
2000	Winkelstein BA, Nightingale RW, Richardson WJ, Myers BS. The cervical facet capsule and its role in whiplash injury: a biomechanical investigation. Spine. May 15, 2000;25(10):1238-1246.
1998	Panjabi MM, Cholewicki J, Nibu K, Grauer J, Babat LB, Dvorak J. Critical load of the human cervical spine: an in vitro experimental study. Clin Biomech (Bristol, Avon). January 1998;13(1):11-17.
1991	Amevo B, Worth D, Bogduk N. Instantaneous axes of rotation of the typical cervical motion segments: a study in normal volunteers. Clin Biomech (Bristol, Avon). May 1991;6(2):111-117.
1986	Gilad I, Nissan M. A study of vertebra and disc geometric relations of the human cervical and lumbar spine. Spine. March 1986;11(2):154-157.
1988	Dvorak J, Froehlich D, Penning L, Baumgartner H, Panjabi MM. Functional radiographic diagnosis of the cervical spine: flexion/extension. Spine. July 1988;13(7):748-755.
1999	Kumaresan S, Yoganandan N, Pintar FA, Maiman DJ. Finite element modeling of the cervical spine: role of intervertebral disc under axial and eccentric loads. Med Eng Phys. December 1999;21(10):689-700.
2007	Siegmund GP, Blouin J-S, Brault JR, Hedenstierna S, Inglis JT. Electromyography of superficial and deep neck muscles during isometric, voluntary, and reflex contraction. J Biomech Eng. February 2007;129(1):66-77.
1998	Vasavada AN, Li S, Delp SL. Influence of muscle morphometry and moment arms on the moment-generating capacity of human neck muscles. Spine. February 15, 1998;23(4):412-422.
2001	Siegmund GP, Myers BS, Davis MB, Bohnet HF, Winkelstein BA. Mechanical evidence of cervical facet capsule injury during whiplash: a cadaveric study using combined shear, compression, and extension loading. Spine. October 1, 2001;26(9):2095-2101.

Year

Entry

1999

Kumaresan S, Yoganandan N, Pintar FA. Finite element analysis of the cervical spine: a material property sensitivity study. Clin Biomech (Bristol, Avon). January 1999;12(1):41-53.

2009

Panzer MB, Cronin DS. C4–C5 segment finite element model development, validation, and load-sharing investigation. J Biomech. March 11, 2009;42(4):480-490.

2007

Anderson AE, Ellis BJ, Weiss JA. Verification, validation and sensitivity studies in computational biomechanics. Comput Methods Biomech Biomed Eng. June 2007;10(3):171-184.

1987

Stokes IAF. Surface strain on human intervertebral discs. J Orthop Res. 1987;5(3):348-355.

1977

Urban JPG, Holm S, Maroudas A, Nachemson A. Nutrition of the intervertebral disk: an in vivo study of solute transport. Clin Orthop Relat Res. November 1977;129:101-114.

1981

Nachemson AL. Disc pressure measurements. Spine. January–February 1981;6(1):93-97.

2008

Jones AC, Wilcox RK. Finite element analysis of the spine: towards a framework of verification, validation and sensitivity analysis. Med Eng Phys. December 2008;30(10):1287-1304.

2000

Bogduk N, Mercer S. Biomechanics of the cervical spine, I: normal kinematics. Clin Biomech (Bristol, Avon). November 2000;15(9):633-648.

2002

Nightingale RW, Winkelstein BA, Knaub KE, Richardson WJ, Luck JF, Myers BS. Comparative strengths and structural properties of the upper and lower cervical spine in flexion and extension. J Biomech. June 2002;35(6):725-732.

1964

Fielding JW. Normal and selected abnormal motion of the cervical spine from the second cervical vertebra to the seventh cervical vertebra based on cineroentgenography. J Bone Joint Surg. December 1964;46A(8):1779-1781.

2004

Pearson AM, Ivancic PC, Ito S, Panjabi MM. Facet joint kinematics and injury mechanisms during simulated whiplash. Spine. February 15, 2004;29(4):390-397.

1996

Lord SM, Barnsley L, Wallis BJ, Bogduk N. Chronic cervical zygapophysial joint pain after whiplash: a placebo-controlled prevalence study. Spine. August 1996;21(15):1737-1744.

2004

Oi N, Pandy MG, Myers BS, Nightingale RW, Chancey VC. Variation of neck muscle strength along the human cervical spine. Stapp Car Crash J. 2004;48:397-417. SAE 2004-22-0017.

1999

Patwardhan AG, Havey RM, Meade KP, Lee B, Dunlap B. A follower load increases the load-carrying capacity of the lumbar spine in compression. Spine. May 15, 1999;24(10):1003-1009.

2011

Curatolo M, Bogduk N, Ivancic PC, McLean SA, Siegmund GP, Winkelstein BA. The role of tissue damage in whiplash-associated disorders: discussion paper 1. Spine. December 2011;36(suppl 25S):S309-S315.

1975

White AA III, Johnson RM, Panjabi MM, Southwick WO. Biomechanical analysis of clinical stability in the cervical spine. Clin Orthop Relat Res. June 1975;109:85-96.

2005

Iatridis JC, MacLean JJ, Ryan DA. Mechanical damage to the intervertebral disc annulus fibrosus subjected to tensile loading. J Biomech. March 2005;38(3):557-565.

1999

Wilke H-J, Neef P, Caimi M, Hoogland T, Claes LE. New in vivo measurements of pressures in the intervertebral disc in daily life. Spine. April 15, 1999;24(8):755-762.

1988

Bogduk N, Marsland A. The cervical zygapophysial joints as a source of neck pain. Spine. June 1988;13(6):610-617.

2000

Patwardhan AG, Havey RM, Ghanayem AJ, Diener H, Meade KP, Dunlap B, Hodges SD. Load-carrying capacity of the human cervical spine in compression is increased under a follower load. Spine. June 15, 2000;25(12):1548-1554.

2001

Panjabi MM, Crisco JJ, Vasavada A, Oda T, Cholewicki J, Nibu K, Shin E. Mechanical properties of the human cervical spine as shown by three-dimensional load-displacement curves. Spine. December 2001;26(24):2692-2700.

2004

Brolin K, Halldin P. Development of a finite element model of the upper cervical spine and a parameter study of ligament characteristics. Spine. February 15, 2004;29(4):376-385.

2012

Seacrist T, Arbogast KB, Maltese MR, García-Espaňa JF, Lopez-Valdes FJ, Kent RW, Tanji H, Higuchi K, Balasubramanian S. Kinetics of the cervical spine in pediatric and adult volunteers during low speed frontal impacts. J Biomech. January 3, 2012;45(1):99-106.

1991

Dvorak J, Panjabi MM, Novotny JE, Antinnes JA. In vivo flexion/extension of the normal cervical spine. J Orthop Res. November 1991;9(6):828-834.

2003

Chancey VC, Nightingale RW, Van Ee CA, Knaub KE, Myers BS. Improved estimation of human neck tensile tolerance: reducing the range of reported tolerance using anthropometrically correct muscles and optimized physiologic initial conditions. Stapp Car Crash J. 2003;47:135-153. SAE 2003-22-0008.

2000

Yoganandan N, Kumaresan S, Pintar FA. Geometric and mechanical properties of human cervical spine ligaments. J Biomech Eng. December 2000;122(6):623-629.

1986

Pooni JS, Hukins DWL, Harris PF, Hilton RC, Davies KE. Comparison of the structure of human intervertebral discs in the cervical, thoracic and lumbar regions of the spine. Surg Radiol Anat. September 1986;8(3):175-182.

2002

Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, Whittle M, D'Lima DD, Cristofolini L, Witte H, Schmid O, Stokes I. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion, I: ankle, hip, and spine. J Biomech. 2002;35(4):543-548.

1995

Barnsley L, Lord SM, Wallis BJ, Bogduk N. The prevalence of chronic cervical zygapophysial joint pain after whiplash. Spine. January 1995;20(1):20-25.

2004

Walsh AJL, Lotz JC. Biological response of the intervertebral disc to dynamic loading. J Biomech. March 2004;37(3):329-337.

2001

Yoganandan N, Kumaresan S, Pintar FA. Biomechanics of the cervical spine, II: cervical spine soft tissue responses and biomechanical modeling. Clin Biomech (Bristol, Avon). January 2001;16(1):1-27.

2009

Winter DA. Biomechanics and Motor Control of Human Movement. 4th ed. Hoboken, NJ: Inc, John Wiley & Sons; 2009.

1995

Stokes IAF, Gardner-Morse M. Lumbar spine maximum efforts and muscle recruitment patterns predicted by a model with multijoint muscles and joints with stiffness. J Biomech. February 1995;28(2):173-186.

1980

Spoor CW, Veldpaus FE. Rigid body motion calculated from spatial co-ordinates of markers. J Biomech. 1980;13(4):391-393.

2009

Yoganandan N, Pintar FA, Zhang J, Baisden JL. Physical properties of the human head: mass, center of gravity and moment of inertia. J Biomech. June 19, 2009;42(9):1177-1192.

2005

Pintar FA, Yoganandan N, Baisden J. Characterizing occipital condyle loads under high-speed head rotation. Stapp Car Crash J. 2005;49:33-47. SAE 2005-22-0002.

1995

Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc B. 1995;57(1):289-300.

1991

Panjabi MM, Oxland TR, Parks EH. Quantitative anatomy of cervical spine ligaments, II: middle and lower cervical spine. J Spinal Disord. September 1991;4(3):277-285.

2012

Mattucci SFE, Moulton JA, Chandrashekar N, Cronin DS. Strain rate dependent properties of younger human cervical spine ligaments. J Mech Behav Biomed Mater. June 2012;10:216-226.

1989

Lind B, Sihlbom H, Nordwall A, Malchau H. Normal range of motion of the cervical spine. Arch Phys Med Rehabil. September 1989;70(9):692-695.

2010

Pintar FA, Yoganandan N, Maiman DJ. Lower cervical spine loading in frontal sled tests using inverse dynamics: potential applications for lower neck injury criteria. Stapp Car Crash J. 2010;54:133-166. SAE 2010-22-0008.

1984

Nissan M, Gilad I. The cervical and lumbar vertebrae: an anthropometric model. Eng Med. July 1984;13(3):111-114.

1988

Moroney SP, Schultz AB, Miller JAA. Analysis and measurement of neck loads. J Orthop Res. September 1988;6(5):713-720.

2000

Winkelstein BA, Nightingale RW, Richardson WJ, Myers BS. The cervical facet capsule and its role in whiplash injury: a biomechanical investigation. Spine. May 15, 2000;25(10):1238-1246.

1998

Panjabi MM, Cholewicki J, Nibu K, Grauer J, Babat LB, Dvorak J. Critical load of the human cervical spine: an in vitro experimental study. Clin Biomech (Bristol, Avon). January 1998;13(1):11-17.

1991

Amevo B, Worth D, Bogduk N. Instantaneous axes of rotation of the typical cervical motion segments: a study in normal volunteers. Clin Biomech (Bristol, Avon). May 1991;6(2):111-117.

1986

Gilad I, Nissan M. A study of vertebra and disc geometric relations of the human cervical and lumbar spine. Spine. March 1986;11(2):154-157.

1988

Dvorak J, Froehlich D, Penning L, Baumgartner H, Panjabi MM. Functional radiographic diagnosis of the cervical spine: flexion/extension. Spine. July 1988;13(7):748-755.

1999

Kumaresan S, Yoganandan N, Pintar FA, Maiman DJ. Finite element modeling of the cervical spine: role of intervertebral disc under axial and eccentric loads. Med Eng Phys. December 1999;21(10):689-700.

2007

Siegmund GP, Blouin J-S, Brault JR, Hedenstierna S, Inglis JT. Electromyography of superficial and deep neck muscles during isometric, voluntary, and reflex contraction. J Biomech Eng. February 2007;129(1):66-77.

1998

Vasavada AN, Li S, Delp SL. Influence of muscle morphometry and moment arms on the moment-generating capacity of human neck muscles. Spine. February 15, 1998;23(4):412-422.

2001

Siegmund GP, Myers BS, Davis MB, Bohnet HF, Winkelstein BA. Mechanical evidence of cervical facet capsule injury during whiplash: a cadaveric study using combined shear, compression, and extension loading. Spine. October 1, 2001;26(9):2095-2101.

Year	Entry
2020	Figueroa LA. Quantifying in Vivo Cervical Spine Kinematics: Validation of a Novel Data Collection and Processing Pipeline [Master's thesis]. Calgary, AB: University of Calgary; July 2020.

Year

Entry

2020

Figueroa LA. Quantifying in Vivo Cervical Spine Kinematics: Validation of a Novel Data Collection and Processing Pipeline [Master's thesis]. Calgary, AB: University of Calgary; July 2020.