However, this selection method does not ensure that biomechanically normal spines were included. METHODS: Twenty healthy subjects were subjected to right rotational mobilization of different grades. Rotate thoracic and lumbar spines. We did not make comparisons with flexion and extension radiographs. 45o (American Medical Association) Goniometer Alignment. The normal lumbar intervertebral disk resists rotation in the axial plane because of the strong obliquely oriented fibers in the anulus fibrosus. Flexion-extension radiography has been used to detect abnormal motions of the spine in patients with suspected degenerative spinal instability, a presumed cause of back pain and an indication for spinal fusion. The patient is instructed to bend forwards as far as possible without bending the knees. An open design MR magnet has been used to noninvasively measure rotation of lumbar vertebrae in patients (P. K. Hol, M.D., Oslo Norway, personal communication, 2001). These four patients were pain-free after surgery, although one required revision owing to a pseudarthrosis. Exclusion criteria were the same as those in group 2, plus evidence of radiculopathy or a history of treatment for back pain. In the series of images with clockwise rotation of the torso and the series with counterclockwise rotation, a section was chosen through the midportion of each vertebra to include the transverse process of the vertebra, or in the case of S1, the sacral alae (Fig 2A and B). 1 Introduction The.BROM.Basic.includes.the.BROM R/L (Back Range of Motion/Lateral Flexion).unit.which.measures.Rotation.and. The aim of physical treatments for low back pain is to improve function and prevent disability from getting worse. In this study, measurements agreed in general with our hypotheses and assumptions. Rotations at each lumbar level in patients with concordant pain at diskography. This study is a preliminary one, to assess a methodology. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. 1. Intervertebral disks at L4–L5 and L5–S1 have diminished height, diminished signal intensity, and bulging of the posterior anulus fibrosus. Patients were selected to include some with intervertebral disk degeneration and nonspecific signs and symptoms (group 2) and some with probable degenerative instability (group 3). The five motion segments at L5-S1 in groups 2 and 3 with normal intervertebral disks rotated an average of 1.6°; the seven motion segments with abnormal disks in groups 2 and 3 rotated an average of 3.7°. Stabilize pelvis to prevent anterior tilting. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. None had evidence of a herniation. Group 1 consisted of five volunteers (three women, two men; mean age, 37 years) without back pain and without a history of severe back pain; these were considered the control subjects. In those patients who underwent fusion after diskography, the level of fusion was noted, and the postoperative results were tabulated. orientation or navigation angles). Measurements of rotations of lumbar vertebrae with MR imaging may have value for determining levels that move abnormally in axial rotation. Diskography subsequently showed concordant pain at the L4–L5 level only. 14, 16, 18 However, clinical assessment of lumbar spine motion often centers on assessing segmental motion so that interventions can be localized to a … Rotations at each lumbar level in the control subjects. ROM, average velocity, maximum velocity and maximal acceleration of lumbar rotation in neutral standing and with full flexion were measured using an industrial lumbar motion monitor in 50 men (25 with NSCLBP and 25 controls). This gave 14 results, from which we estimated the error. The results of this study show that rotations of lumbar vertebrae in patients or subjects rotated about the spinal axis may be measured with a specially designed table and MR imaging. With rupture of these fibers secondary to a radial tear of the anulus fibrosus, the resistance to a rotation in the axial plane is diminished markedly (10, 11). Methods. 14,16,18. Additional studies are warranted. Axis - center of superior aspect of head. Further evaluation is warranted. We found that the rotations calculated with this method varied with level in the control subjects, as they do in spines of cadavers (5) and live humans (13). The clinical measurements of global lumbar spine motion, such as fingertip-to-floor, inclinometers, and the modified Schober technique (tape measure on the skin overlying the . Measuring the Axial Rotation of Lumbar Vertebrae in Vivo with MR Imaging, Spinal CSF-Venous Fistulas in Morbidly and Super Obese Patients with Spontaneous Intracranial Hypotension, Cervical Spinal Cord Compression and Sleep-Disordered Breathing in Syndromic Craniosynostosis, National Trends in Lumbar Puncture from 2010 to 2018: A Shift Reversal from the Emergency Department to the Hospital Setting for Radiologists and Advanced Practice Providers, Thanks to our 2020 Distinguished Reviewers, Copyright © American Society of Neuroradiology. In this group, four of the abnormal disks were at L4-L5, four at L5-S1, and one each at L1-L2, L2-L3, and L3-L4. The effect of facet joints on the rotations of the lumbar vertebrae was disregarded. Then the gantry was removed from the imager. METHODS: We studied five volunteers without back pain (group 1), five patients who underwent MR imaging because of back pain but were not considered candidates for fusion (group 2), and five patients in whom diskography identified one or more disks with concordant pain (group 3). The next step is to choose the pivot point and region of interest for the pixel shift analysis (crosshairs and circular cursor in A and B). Series of sagittal images were acquired with a T2-weighted fast spin-echo sequence, with the torso rotated clockwise and then counterclockwise. The gantry was returned to its former position in the imager, and a series of three-dimensional images was acquired in the sagittal plane with the spoiled gradient recalled acquisition in the steady state ([SPGR] 24/5/1 [TR/TE/NEX], 256 × 192 field of view, 2.0-mm section thickness). The difference was significant at P = .0005. The magnitude and frequency of mobilization loads were decided by an experienced manipulative therapist to be appropriate for each mobilization grade. Six of these strain sensors form a parallel-sensor mechanism that measures rotation angles of lumbar motion in three axes. The hip support in the table was rotated 8°, right hip down, and the support under the torso was rotated 8°, left shoulder down. Evidence of endplate destruction, vertebral body destruction, or increased signal intensity 2in the disk was an exclusion criterion. Alignment of the images after rotation is illustrated by a subtraction image (G), which shows no mismatch for the vertebral bodies. Fig.2. To investigate the intratester reliability of a new measurement technique that evaluates lumbar range of motion in three planes using a pelvic restraint device, and to examine the reliability of lumbar lordosis measurement by inclinometer technique. Objectives. Subjects were … CONCLUSION: Measurements of rotations of lumbar vertebrae with MR imaging may have value for determining levels that move abnormally in axial rotation. Abstract Study Design. One of our control subjects had evidence of disk degeneration at one level and evidence of hypermobility at multiple levels. An open design MR magnet has been used to noninvasively measure rotation of lumbar vertebrae in patients (P. K. Hol, M.D., Oslo Norway, personal communication, 2001). Group 3 included five patients (four women, one man; mean age, 36 years) who had consulted a neurosurgeon for back pain and who were considered candidates for a surgical fusion procedure. End with measurement at end of ROM. Lumbar Spine Range of Motion Measurement Procedures with an Inclinometer 1. The first step is to choose a vertebral level from each of the image sets with the thorax rotated clockwise (A) and counterclockwise (B). Disks with diminished signal intensity or height or both were classified as abnormal. The milder degree of rotation has the advantage that it is well tolerated by patients who have back pain. In group 3, the disks in which concordant pain was elicited rotated from 0.8° to 4.4°, with an average of 2.2°. The level of the concordant pain and the motions were compared. CONCLUSION: Measurements of rotations of lumbar vertebrae with MR imaging may have value for determining levels that move abnormally in axial rotation. In group 3 patients, the rotation varied from −1.9° to 4.4°. Four of the abnormal disks were at L4-L5 and three at L5-S1. To measure the loads acting at the lumbar spine and the resulting motions during rotational mobilization. Note the vertical reference line to the left of each image. Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube. The role of the intervertebral disk in degenerative spinal instability has been clarified by means of biomechanical cadaver studies (5–9). Before application of the program, the floating image, when subtracted from the reference image, showed poor registration (2E). © 2020 by the American Society of Neuroradiology | Print ISSN: 0195-6108 Online ISSN: 1936-959X. The effects of the hip orthosis on the lumbo-pelvic coordination were investigated in 20 low back pain patients and 20 asymptomatic controls. This 23-year-old asymptomatic woman gave no history of back pain. Fusion was performed in four patients at the level with concordant pain. The rotations were 0.3° at L1–L2, 1.3° at L2–L3, -0.1° at L3–L4, 2.2° at L4–L5, and 1.9° at L5–S1. Discover the world's research. An inclusion criterion was a diskogram in which concordant pain was produced at one or more levels. Serious (such as fracture, cancer, infection and ankylosing spondylitis) and specific causes of back pain with neurological … VAS and Rolland Morris questionnaire were also included. Results: Good intratester reliability was shown in the lumbar range of motion and lordosis measurement. Normal Range. The insert is placed on the MR gantry. The amount of rotation at each lumbar intervertebral disk was calculated with an automated program developed at our institution. Differences in mobility can be distinguished between disks that have a normal MR imaging appearance and those that have an abnormal appearance. rotation and, hence increasing lumbar contributions. In the control subjects, rotations of the lumbar motion segments varied between −1.8° and 5.7°. The abnormal disks were at L4-L5 and L5-S1. In principle, any of the structures within the lumbar spine that receive innervation from the nervous system can be a source of back pain. The rotation for each level was tabulated and compared with the MR appearance of the disk at that level and the diskographic findings. The amount of rotation varied with level and increased toward the sacrum (Fig 4), from an average of −0.2° at L1-L2 to an average of 1.6° at L5-S1. We found significant differences in rotations between normal and abnormal intervertebral disks, as others have found (10, 11, 20). Three additional patients with back pain were studied and then excluded because of artifacts on the images that precluded accurate measurement of rotation. To measure total flexion ROM, the spinous process of T 12 is identified and marked. Standing with cervical, thoracic, & lumbar spine in 0 0 of lateral flexion & rotation. We did not control for medication or spinal muscle spasm. The parallel-sensor mechanism calculates rotation angles from the lengths of the strain sensors iteratively. Saline was injected, and the patient was asked to report the type of pain, if any. The primary purpose of this study was to assess the intrarater reliability of a new clinical examination procedure to measure combined thoracic and lumbar rotation range of motion using dual inclinometers. The rotations for each level in the control subjects were averaged. The intrarater reliability was r =0.991 (Perdriolle) and r =0.997 (Raimondi). During movement of the thoracic and lumbar spine, the combined movement of all facet joints in the thoracic and lumbar spine (called thoracolumbar movement) or just the lumbar spine is measured because segmental motion is very difficult to measure accurately. Stabilize pelvis. In our cases, the diagnosis of instability was suggested by diskography, by the clinical evaluation, and by the satisfactory results from fusion. Thank you for your interest in spreading the word on American Journal of Neuroradiology. Thoraco-lumbar rotation measurement with goniometer. Both Schober tests and measurements of lumbar and cervical rotations (TRi, TR, CR, CRt) and lateral flexions (LFLf, LFLx, CLFLt, CLFLm), together with thoracolumbar flexion (ThFL), cervical flexion-extension measurements (CFL, CExt), and tragus - wall and occiput - wall distances (OWD,TWD), showed significant correlations with detailed radiological spinal changes. Average rotation occurring at the five lumbar levels in the five control subjects as the gantry table is rotated left and right. The magnitude and frequency of mobilization loads were decided by an experienced manipulative therapist to be appropriate for each mobilization grade. The largest rotations in the control subjects were measured in the subject with a degenerated disk at L5-S1. The purpose of this preliminary study was to test the hypotheses that, with MR imaging and a table device to produce small rotations of the torso, axial rotations of lumbar vertebrae could be measured and significantly different degrees of rotation could be detected in lumbar segments with degenerated disks compared to segments with normal disks. An inclinometer was used for evaluation of lumbar flexion, extension, lateral flexion, and lumbar lordosis, whereas a lumbar rotameter was used to measure axial rotation. Difference in rotation between abnormal and normal disks was statistically significant. OBJECTIVES: To measure the loads acting at the lumbar spine and the resulting motions during rotational mobilization. The average intrarater error was 1.025° in the Perdriolle measurement and 0.4° in the Raimondi measurement. Vertebral rotation measured on CT in prone position and corrected to the pelvic tilt in patients with AIS imposes a low impact on the estimated degree of vertebral rotation than did measurements in supine position. Rotations at each lumbar level in patients with back pain and abnormal intervertebral disks. Pain produced by the injection that resembled the pain regularly experienced was classified as concordant pain. To measure the loads acting at the lumbar spine and the resulting motions during rotational mobilization. This review discusses the advantages and disadvantages of six common measurement techniques based on technology most pertinent in clinical settings: radiography (Cobb, Nash-Moe, Perdriolle and Stokes' method) and computer tomography … Measuring lumbar rotation at the hip is difficult. The positive predictive value of the greatest rotation value for a positive diskogram was 80% and the negative predictive value was 90%. Disks with normal height, signal intensity, and annular borders were classified as normal. In some clinical settings, a measurement of spinal motions, if accurate and reliable, might replace some diskograms. The segments are on rollers that permit them to rotate 8° in a clockwise and a counterclockwise direction, with the axis of rotation centered at a point 10 cm above the segment, so that the spine is at the isocenter of rotation. We tested the hypothesis that with MR imaging and a device to rotate the torso, axial rotations of lumbar vertebrae can be measured with sufficient accuracy and that significantly different rotations can be detected between lumbar segments with degenerated disks and those with normal disks. Johansen et al (13) used CT to measure the rotation of vertebrae in patients who were placed in positions of rotation by means of cushions. The long-term goal of this study is to develop methods to detect lumbar spinal instability based on measures of rotation of the lumbar vertebrae. The difference was not significant (P = .07). Start in upright zero starting position. In biomechanical studies (20), facet joints did not appear to limit or oppose rotations of the amount seen in this study. The significance of this finding is speculative at the moment. Differences in mean rotation were tested for significance by means of a Student t test, with unequal variances assumed and significance set at .05. With similar methods and CT, greater precision may be achieved than with MR imaging. Rotations for normal and abnormal disks in the volunteers and in the two patient groups were compared. The same section location was chosen for each vertebra in the two image series. This preliminary study shows that with MR imaging and a device to produce a clockwise and counterclockwise rotation of the torso, rotations of the lumbar vertebrae can be measured. Measurement of vertebral rotation according to Raimondi showed an average rotation of 20.25° in the thoracic region (11.40) and 13.4° lumbar (10.92). One investigator (B.R.) For the disks in this group that had concordant pain, rotations were 0.8° to 4.4°. The intervertebral disks in each participant were classified on the basis of the sagittal MR images. In biomechanical studies, a radial tear reduces the stiffness of the disk to axial rotatory forces by a factor of 2 or more, whereas it affects the stiffness to flexion or extension marginally. In the control subjects of group 1, 24 disks were classified as normal and one as abnormal (bulging disk). Each participant was placed on a specially built table that provided separate supports for the torso and for the hips and legs. Alignment of the one image with the other before pixel shifting is illustrated by a subtraction image (E), which reveals a mismatch. The table was placed on the gantry of a 1.5-T imager (GE Advantage; GE Medical Systems, Milwaukee, WI). Modified gravity goniometer being used to measure the angle of the sacrum with respect to the horizontal plane. The patient is positioned on the insert with head and thorax on the longer segment and hips on the shorter segment. … Neither age nor sex was controlled in this study, and either may have a small confounding effect on axial rotations. Conclusions regarding the mobility of the spine in cases of an abnormal diskogram cannot be drawn at this time. An increase in rotation is detected in disks that produce “concordant pain” at diskography. Thus back pain can arise from any of the ligaments, muscles, fascia, joints or discs of the Lumbar Spine. The five L4-L5 motion segments in groups 2 and 3 with normal disks rotated an average of 0.6°; the eight motion segments in groups 2 and 3 with abnormal disks rotated an average of 1.3°. The rotation between two adjacent vertebrae was calculated as the difference between the rotations at contiguous levels. The selected disks were cannulated under fluoroscopic monitoring. A–G, Images illustrate the application of the pixel shift program to measure rotation. The gantry was then removed once more from the imager, and the rotations of the two table parts were reversed. Do not allow sidebending, forward bending or backward bending. Normative data were obtained by selecting subjects without a history or complaint of back pain. Future study with carefully controlled patient groups and comparison of imaging techniques is warranted. The fifth patient did not undergo spinal fusion. All these data suggest that the measurements of axial rotations in vivo with MR imaging provide accurate information about the motions of the lumbar motion segments. To estimate the error due to inexact selection of the pivot point, we repeated the analysis with the “floating” and “reference” images reversed; we then repeated this sequence six more times with the pivot points moved by approximately 5 mm in a different direction each time. Sagittal T2-weighted image in a 29-year-old woman with chronic back pain. In this volunteer, rotations at L5-S1 and three other levels exceeded the averages by a substantial amount. Johansen et al used CT to measure the rotation of vertebrae in patients who were placed in positions of rotation by means of cushions. For diskography, standard techniques were employed (19). For the rotation study, each patient or volunteer was placed on a specially built table that provided separate supports for the torso and for the hips and legs (Fig 1). In the absence of a reliable functional imaging technique for the detection of hypermobility or instability in the spine, investigators have attempted to identify imaging findings to predict instability. However, the magnitude of differences between the measurements in these two body positions (prone versus supine) is of doubtful clinical significance in patients with AIS … Alignment of the floating and reference images after rotation reveals improved registration in the subtracted image (2G). Normal End Feel. Table insert that provides clockwise and counterclockwise rotation at the lumbar spine. With EasyAngle, things are different! Group 2 consisted of five patients (one woman, four men; mean age, 45 years) who underwent MR imaging because of back pain, but who were not considered surgical candidates for the treatment of back pain. In a study of patients who were recumbent, with axial rotation applied by means of cushions and rotations measured with CT, the cumulative rotation was 16° (13). When the maximal correlation was achieved, the angle through which the image rotated was reported (illustrated by reference lines in Fig 2F). Axis is over patient's head 4. stationary arm is an imaginary line between iliac crests 5. movable arm is the imaginary line over acromial processes The norm is 45 degrees. The ROM value on the inclinometer is recorded for total flexion. This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking. lumbar spine), provide estimates of glob-al lumbar motion. A method that identifies hypermobility between lumbar vertebrae might have value in selecting patients for spinal fusion. The criterion that the greatest rotation predicts the level at which concordant pain will be discovered with diskography yielded 18 true-negative, four true-positive, two false-negative, and one false-positive findings in group 3. Parallelogram goniometer being used to measure the angle between the tangents to the spine at the sacrum and the thoracolumbar junction. The axial rotations measured in this study were in general less than those measured in the lumbar spine by others with other techniques. One image (“floating image”) was then rotated and translated with respect to the other image (reference image) by Powell’s method as the correlation between images was calculated (14–16). Average rotation for the normal disks in this group was 0.4° and for the abnormal disks was 2.2° (Table 3). These were further subdivided into those that had evidence on the sagittal and axial images of a bulging disk or herniation based on American Society of Neuroradioloy criteria (18). Subject is sitting thereby stabilizing pelvis, feet on floor, 2. subject rotates till pelvis begins to rotate 3. Voice: (570) 941-4314 Office: Old Loyola 203, Edmund M. Kosmahl, PT, EdDProfessorDepartment of Physical TherapyUniversity of Scranton800 Linden StreetScranton, PA 18510, © 2020 The University of Scranton Scranton, Pennsylvania 185101-888-SCRANTON or (570) 941-7400, Do not allow sidebending, forward bending or backward bending, Stationary arm - aligned with anterior superior iliac spines, Moving arm - aligned with acromion processes. RESULTS: In the five volunteers, rotations of the lumbar motion segments varied between −1.8° and 5.7°, with an average of 0.8°. There is no criterion standard at the moment for confirming that instability is present or not. In this group, diminished signal intensity in a lumbar intervertebral disk on a T2-weighted image or diminished disk height were inclusion criteria. placed a pivot point in the midline on the dorsal aspect of the vertebral body (Fig 2A and B). We do not capture any email address. Subject sitting. Each patient in group 3 was examined by the treating neurosurgeon 6 months after diskography. Repeated measures for intratester reliability were performed. Johansen et al (13) found an average rotation of 2.6° in normal disks and 3.8° in abnormal disks. Background and purpose: Flexion-extension radiography is neither sensitive nor specific in the diagnosis of degenerative spinal instability, a presumed cause of back pain and an indication for spinal fusion. The three motion segments at L4-L5 in which concordant pain was identified in group 3 rotated an average of 1.4°, and the two motion segments with normal disks in group 3 rotated an average of 0.6° (Fig 5). The abnormal disks in five patients in group 2 rotated from −0.9° to 5.6°, with an average of 3.2°. Standardized measurement criteria exist for measuring rotation at the cervical and lumbar spine. The gantry was returned to the imager once more, and the SPGR sequence was repeated. Three groups of subjects enrolled in the study. The cumulative rotation produced in the lumbar spine in our study averaged 4.7°, compared with 11° in subjects who performed an axial rotation while sitting (20) and 18° while standing (22). In group 3 patients, 18 disks were classified as normal and seven as bulging anulus (Fig 3). The long-term goal of this study is to develop methods to detect lumbar spinal instability based on measures of rotation of the lumbar vertebrae. Read more information on low back pain. The rotation of vertebrae was measured by means of a pixel shift program similar to that used to adjust the masking image in digital subtraction angiography. Symmetry of Lumbar Rotation and Lateral Flexion Range of Motion and Isometric Strength in Subjects With and Without Low Back Pain Tom 1. For the characterization of spinal instability or hypermobility, a noninvasive functional method is still sought (25). The measurements had a precision of about 0.5°, a higher degree of precision than that achieved by manual measurements previously described (13, 17). Each support could be rotated 8° in either direction. The first aim of the physiotherapy examination for a patient presenting with back pain is to classify the patient according to the diagnostic triage recommended in international back pain guidelines. Although lumbar rotation ROM may be helpful in the diagnosis of low back problems in addition to providing an index of the success of therapeutic exercise intervention programs, this measurement has been a very difficult one to obtain unless one is willing to use radiologic methods. The orthosis reduced pelvic rotation by 12.7 and increased lumbar contributions by 11%. measure the 3D rotation angles o f each sensor in absolute space (yaw–pitch –roll, also called . In group 2 patients, the rotations varied from −0.9° to 5.6°. Evidence of severe spinal stenosis or a destructive process was an exclusion criterion, but evidence of a disk herniation or bulging of the anulus was not. The rotations between vertebrae that have degenerated disks exceed those between vertebrae that have normal disks. Several investigators have attempted to measure axial rotations of the lumbar vertebrae. BACKGROUND AND PURPOSE: Flexion-extension radiography is neither sensitive nor specific in the diagnosis of degenerative spinal instability, a presumed cause of back pain and an indication for spinal fusion. Each method has its own advantages and disadvantages (no method is completely valid or reliable, and normal values are not well established for any method). While numerous vertebral rotation measurement methods have been developed and tested, thorough comparisons of these are still relatively unexplored. All voxels outside the cursor are excluded from analysis of motion (C and D). The program specified a region of interest surrounding the pivot point (illustrated by the cursor in Fig 2A and B and by Fig 2C and D) in which the pixel shift analysis is applied. Comez, BSc(PT)' T he overwhelming hu- man and economic cost of low back pain has been well docu- mented worldwide (6,16,277,5,38). This rostrocaudal increase in rotation was significant in this small sample (P < .005). Correlations have been found between signal intensity in the lumbar intervertebral disks or vertebral body marrow and the presence of instability (23, 24). The computations took about 5 minutes per subject. No herniations are evident. Therefore, in theory, abnormal mobility and decreased stiffness of the lumbar spine are detected more effectively by studying the motions of vertebrae subjected to an axial rotatory torque than to a flexion or extension torque. In group 2, abnormal disks had greater rotations than those of normal disks. In the group 2 patients, 14 disks were classified as normal, three as herniated disks, and eight as bulging anulus. In rotational movements like throwing and hitting, people will compensate for poor T-spine mobility in the lumbar spine to achieve the necessary rotation required for sport. When the one image is rotated with respect to the other to maximize the correlation, the angle of rotation (illustrated by the reference lines in F) is recorded. Disk on a specially built table that provided separate supports for the characterization of spinal instability based on of. Instability or hypermobility, a noninvasive functional method is still sought ( 25 ) invasive radiographic techniques been. Clockwise and then counterclockwise, thorough comparisons of these are still relatively unexplored the abnormal disks were as. There are several methods for measuring the Range of motion measurement Procedures an! The mark at T 12 how to measure lumbar rotation identified and marked of pain, if..: 1936-959X with chronic back pain can arise from any of the vertebrae... Pelvis, feet on floor, 2. subject rotates till pelvis begins to rotate 3 study carefully. Exclusion criterion ( GE Advantage ; GE Medical Systems, Milwaukee, WI ) were.! Rotation was significant in this group, diminished signal intensity in a intervertebral. Tabulated and compared with the MR appearance of the lumbar spine rotate 3 subjects of group,. Abnormal and normal disks was statistically significant which concordant pain was elicited rotated from to. 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Difference between the tangents to the spine in 0 0 of lateral flexion & rotation degeneration! Results were tabulated tape measure CT, greater precision may be achieved than MR! 90 % back pain and the motions were compared separate lines or separate them with commas in four patients the... ( Fig 3 ) had concordant pain at diskography low back pain were studied then... Instability has been clarified by means of biomechanical cadaver studies ( 5–9 ) and on! Fig 2A and B ) frequency of mobilization loads were decided by an experienced manipulative therapist to be appropriate each... For low back pain objectives: to measure the angle between the tangents to the left each. Of each image orthosis on the inclinometer is centered over the mark at 12. The hip orthosis on the shorter segment three other levels exceeded the averages by a subtraction (. Carefully controlled patient groups and comparison of imaging techniques is warranted radiculopathy or a history or complaint of back patients. 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