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Standard of Care Cervical Spine Flexion/Extension Radiograph Measurements Do Not Predict Multiplanar Intervertebral

Christopher J Como^1,2, Clarissa M LeVasseur³, Anthony A Oyekan^1,2

¹Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA 15213; Pittsburgh Orthopaedic Spine Research (POSR) Group, Pittsburgh, PA 15213.

Journal of Biomechanical Engineering

|March 4, 2025

Summary

End-range neck flexion/extension range of motion (ROM) strongly predicts mid-range ROM but weakly predicts axial rotation ROM. Current evaluation methods are insufficient for capturing full cervical spine multiplanar motion.

Keywords:

anterior cervical discectomy and fusion biomechanics cervical spine in vivo kinematics intervertebral motion physiological motion spine spine surgery

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Area of Science:

Biomechanics
Spinal Imaging
Orthopedics

Background:

Cervical spine evaluation often uses limited end-range flexion/extension radiographs.
These standard methods may not fully assess mid-range or multiplanar cervical spine motion.
Understanding cervical spine motion is crucial for diagnosing and managing neck pain.

Purpose of the Study:

To determine if end-range flexion/extension range of motion (ROM) predicts axial rotation ROM or mid-range ROM in patients with neck pain and controls.
To investigate the predictive relationship between different planes of cervical spine motion.
To assess the adequacy of current radiographic assessment methods for cervical spine motion.

Main Methods:

Dynamic flexion/extension and axial rotation were performed by 75 surgical patients and 71 asymptomatic controls.
Synchronized biplane radiographs were captured at 30 images per second.
Intervertebral motion (C2-C7) was tracked using CT-based bone models and validated volumetric tracking.

Main Results:

End-range flexion/extension ROM strongly predicted mid-range flexion/extension ROM across all subaxial segments (r=0.61 to 0.91).
End-range flexion/extension ROM weakly to moderately predicted mid-range (ρ=0.002 to 0.50) and end-range (r=0.2 to 0.68) axial rotation ROM.
Significant differences were observed in predictive power between motion planes.

Conclusions:

End-range flexion/extension range of motion (ROM) is a poor predictor of axial rotation ROM in the cervical spine.
Current standard clinical assessments of cervical spine motion are insufficient.
A comprehensive evaluation of multiplanar cervical spine motion is needed for accurate patient assessment.