Research Papers

Capturing Three-Dimensional In Vivo Lumbar Intervertebral Joint Kinematics Using Dynamic Stereo-X-Ray Imaging

[+] Author and Article Information
Ameet K. Aiyangar

EMPA (Swiss Federal Laboratories
for Materials Science and Research),
Mechanical Systems Engineering (Lab 304),
Ueberlandstrasse 129,
Duebendorf 8400, Switzerland
Department of Orthopaedic Surgery,
University of Pittsburgh,
3820 South Water Street,
Pittsburgh, PA 15203
e-mail: ameetaiyangar@gmail.com

Liying Zheng

Department of Orthopaedic Surgery,
Musculoskeletal Modeling Laboratory,
University of Pittsburgh,
3820 South Water Street,
Pittsburgh, PA 15203
e-mail: zlyreed@gmail.com

Scott Tashman

Department of Orthopaedic Surgery,
Department of Bioengineering,
Orthopaedic Biodynamics Laboratory,
University of Pittsburgh,
3820 South Water Street,
Pittsburgh, PA 15203
e-mail: tashman@pitt.edu

William J. Anderst

Department of Orthopaedic Surgery,
Orthopaedic Biodynamics Laboratory,
University of Pittsburgh,
3820 South Water Street,
Pittsburgh, PA 15203
e-mail: anderst@pitt.edu

Xudong Zhang

Department of Orthopaedic Surgery,
Department of Bioengineering,
Department of Mechanical Engineering and Materials Science,
Musculoskeletal Modeling Laboratory,
University of Pittsburgh,
3820 South Water Street,
Pittsburgh, PA 15203
e-mail: xuz9@pitt.edu

There were other tasks performed by the subject, which were not reported here. The total effective radiation dose was estimated to be well under 3.6 mSv.

1Corresponding author.

Contributed by the Bioengineering Division of ASME for publication in the JOURNAL OF BIOMECHANICAL ENGINEERING. Manuscript received May 3, 2013; final manuscript received October 14, 2013; accepted manuscript posted October 22, 2013; published online November 26, 2013. Assoc. Editor: Brian D. Stemper.

J Biomech Eng 136(1), 011004 (Nov 26, 2013) (9 pages) Paper No: BIO-13-1215; doi: 10.1115/1.4025793 History: Received May 03, 2013; Revised October 14, 2013; Accepted October 22, 2013

Availability of accurate three-dimensional (3D) kinematics of lumbar vertebrae is necessary to understand normal and pathological biomechanics of the lumbar spine. Due to the technical challenges of imaging the lumbar spine motion in vivo, it has been difficult to obtain comprehensive, 3D lumbar kinematics during dynamic functional tasks. The present study demonstrates a recently developed technique to acquire true 3D lumbar vertebral kinematics, in vivo, during a functional load-lifting task. The technique uses a high-speed dynamic stereo-radiography (DSX) system coupled with a volumetric model-based bone tracking procedure. Eight asymptomatic male participants performed weight-lifting tasks, while dynamic X-ray images of their lumbar spines were acquired at 30 fps. A custom-designed radiation attenuator reduced the radiation white-out effect and enhanced the image quality. High resolution CT scans of participants' lumbar spines were obtained to create 3D bone models, which were used to track the X-ray images via a volumetric bone tracking procedure. Continuous 3D intervertebral kinematics from the second lumbar vertebra (L2) to the sacrum (S1) were derived. Results revealed motions occurring simultaneously in all the segments. Differences in contributions to overall lumbar motion from individual segments, particularly L2–L3, L3–L4, and L4–L5, were not statistically significant. However, a reduced contribution from the L5–S1 segment was observed. Segmental extension was nominally linear in the middle range (20%–80%) of motion during the lifting task, but exhibited nonlinear behavior at the beginning and end of the motion. L5–S1 extension exhibited the greatest nonlinearity and variability across participants. Substantial AP translations occurred in all segments (5.0 ± 0.3 mm) and exhibited more scatter and deviation from a nominally linear path compared to segmental extension. Maximum out-of-plane rotations (<1.91 deg) and translations (<0.94 mm) were small compared to the dominant motion in the sagittal plane. The demonstrated success in capturing continuous 3D in vivo lumbar intervertebral kinematics during functional tasks affords the possibility to create a baseline data set for evaluating the lumbar spinal function. The technique can be used to address the gaps in knowledge of lumbar kinematics, to improve the accuracy of the kinematic input into biomechanical models, and to support development of new disk replacement designs more closely replicating the natural lumbar biomechanics.

Copyright © 2014 by ASME
Your Session has timed out. Please sign back in to continue.


Rohlmann, A., Zander, T., Schmidt, H., Wilke, H. J., and Bergmann, G., 2006, “Analysis of the Influence of Disc Degeneration on the Mechanical Behaviour of a Lumbar Motion Segment Using the Finite Element Method,” J. Biomech., 39(13), pp. 2484–2490. [CrossRef] [PubMed]
Christophy, M., Faruk Senan, N. A., Lotz, J. C., and O'Reilly, O. M., 2012, “A Musculoskeletal Model for the Lumbar Spine,” Biomech. Model. Mechanobiol., 11(1–2), pp. 19–34. [CrossRef] [PubMed]
de Zee, M., Hansen, L., Wong, C., Rasmussen, J., and Simonsen, E. B., 2007, “A Generic Detailed Rigid-Body Lumbar Spine Model,” J. Biomech., 40(6), pp. 1219–1227. [CrossRef] [PubMed]
Bifulco, P., Cesarelli, M., Cerciello, T., and Romano, M., 2012, “A Continuous Description of Intervertebral Motion by Means of Spline Interpolation of Kinematic Data Extracted by Videofluoroscopy,” J. Biomech., 45(4), pp. 634–641. [CrossRef] [PubMed]
Li, G. A., Wang, S. B., Passias, P., Xia, Q., Li, G., and Wood, K., 2009, “Segmental in Vivo Vertebral Motion During Functional Human Lumbar Spine Activities,” Eur. Spine J., 18(7), pp. 1013–1021. [CrossRef] [PubMed]
Rozumalski, A., Schwartz, M. H., Wervey, R., Swanson, A., Dykes, D. C., and Novacheck, T., 2008, “The in Vivo Three-Dimensional Motion of the Human Lumbar Spine During Gait,” Gait Posture, 28(3), pp. 378–384. [CrossRef] [PubMed]
Panjabi, M. M., 1992, “The Stabilizing System of the Spine. Part I. Function, Dysfunction, Adaptation, and Enhancement,” J. Spinal Disord., 5(4), pp. 383–389; discussion 397. [CrossRef] [PubMed]
Panjabi, M. M.1992, “The Stabilizing System of the Spine. Part II. Neutral Zone and Instability Hypothesis,” J. Spinal Disord., 5(4), pp. 390–396; discussion 397. [CrossRef] [PubMed]
Adams, M., Bogduk, B., Burton, K., and Dolan, P., 2006, The Biomechanics of Back Pain, Churchill Livingstone, New York.
Anderst, W. J., Vaidya, R., and Tashman, S., 2008, “A Technique to Measure Three-Dimensional in Vivo Rotation of Fused and Adjacent Lumbar Vertebrae,” Spine J., 8(6), pp. 991–997. [CrossRef] [PubMed]
Zhang, X., and Xiong, J., 2003, “Model-Guided Derivation of Lumbar Vertebral Kinematics in Vivo Reveals the Difference Between External Marker-Defined and Internal Segmental Rotations,” J. Biomech., 36(1), pp. 9–17. [CrossRef] [PubMed]
Pearcy, M., Portek, I., and Shepherd, J., 1984, “Three-Dimensional X-Ray Analysis of Normal Movement in the Lumbar Spine,” Spine, 9(3), pp. 294–297. [CrossRef] [PubMed]
Passias, P. G., Wang, S. B., Kozanek, M., Xia, Q., Li, W. S., Grottkau, B., Wood, K. B., and Li, G. A., 2011, “Segmental Lumbar Rotation in Patients With Discogenic Low Back Pain During Functional Weight-Bearing Activities,” J. Bone Joint Surg. Am. Vol., 93A(1), pp. 29–37. [CrossRef]
Wang, S., Xia, Q., Passias, P., Wood, K., and Li, G., 2009, “Measurement of Geometric Deformation of Lumbar Intervertebral Discs Under In-Vivo Weightbearing Condition,” J. Biomech., 42(6), pp. 705–711. [CrossRef] [PubMed]
Fujii, R., Sakaura, H., Mukai, Y., Hosono, N., Ishii, T., Iwasaki, M., Yoshikawa, H., and Sugamoto, K., 2007, “Kinematics of the Lumbar Spine in Trunk Rotation: in Vivo Three-Dimensional Analysis Using Magnetic Resonance Imaging,” Eur. Spine J., 16(11), pp. 1867–1874. [CrossRef] [PubMed]
Ochia, R. S., Inoue, N., Renner, S. M., Lorenz, E. P., Lim, T. H., Andersson, G. B., and An, H. S., 2006, “Three-Dimensional in Vivo Measurement of Lumbar Spine Segmental Motion,” Spine, 31(18), pp. 2073–2078. [CrossRef] [PubMed]
Gracovetsky, S., Newman, N., Pawlowsky, M., Lanzo, V., Davey, B., and Robinson, L., 1995, “A Database for Estimating Normal Spinal Motion Derived From Noninvasive Measurements,” Spine, 20(9), pp. 1036–1046. [CrossRef] [PubMed]
Leardini, A., Chiari, L., Della Croce, U., and Cappozzo, A., 2005, “Human Movement Analysis Using Stereophotogrammetry. Part 3. Soft Tissue Artifact Assessment and Compensation,” Gait Posture, 21(2), pp. 212–225. [CrossRef] [PubMed]
Cappozzo, A., Catani, F., Leardini, A., Benedetti, M. G., and Croce, U. D., 1996, “Position and Orientation in Space of Bones During Movement: Experimental Artefacts,” Clin. Biomech. (Bristol, Avon), 11(2), pp. 90–100. [CrossRef] [PubMed]
Gonnella, C., Paris, S. V., and Kutner, M., 1982, “Reliability in Evaluating Passive Intervertebral Motion,” Phys. Therapy, 62(4), pp. 436–444.
Dickey, J. P., Pierrynowski, M. R., Bednar, D. A., and Yang, S. X., 2002, “Relationship Between Pain and Vertebral Motion in Chronic Low-Back Pain Subjects,” Clin. Biomech. (Bristol, Avon), 17(5), pp. 345–352. [CrossRef] [PubMed]
Steffen, T., Rubin, R. K., Baramki, H. G., Antoniou, J., Marchesi, D., and Aebi, M., 1997, “A New Technique for Measuring Lumbar Segmental Motion in Vivo. Method, Accuracy, and Preliminary Results,” Spine, 22(2), pp. 156–166. [CrossRef] [PubMed]
Kanayama, M., Abumi, K., Kaneda, K., Tadano, S., and Ukai, T., 1996, “Phase Lag of the Intersegmental Motion in Flexion-Extension of the Lumbar and Lumbosacral Spine—An in Vivo Study,” Spine, 21(12), pp. 1416–1422. [CrossRef] [PubMed]
Kanayama, M., Tadano, S., Kaneda, K., Ukai, T., Abumi, K., and Ito, M., 1995, “A Cineradiographic Study on the Lumbar Disc Deformation During Flexion and Extension of the Trunk,” Clin. Biomech. (Bristol, Avon), 10(4), pp. 193–199. [CrossRef] [PubMed]
Harada, M., Abumi, K., Ito, M., and Kaneda, K., 2000, “Cineradiographic Motion Analysis of Normal Lumbar Spine During Forward and Backward Flexion,” Spine, 25(15), pp. 1932–1937. [CrossRef] [PubMed]
Okawa, A., Shinomiya, K., Komori, H., Muneta, T., Arai, Y., and Nakai, O., 1998, “Dynamic Motion Study of the Whole Lumbar Spine by Videofluoroscopy,” Spine, 23(16), pp. 1743–1749. [CrossRef] [PubMed]
Wong, K. W., Leong, J. C., Chan, M. K., Luk, K. D., and Lu, W. W., 2004, “The Flexion-Extension Profile of Lumbar Spine in 100 Healthy Volunteers,” Spine, 29(15), pp. 1636–1641. [CrossRef] [PubMed]
Wong, K. W., Luk, K. D., Leong, J. C., Wong, S. F., and Wong, K. K., 2006, “Continuous Dynamic Spinal Motion Analysis,” Spine, 31(4), pp. 414–419. [CrossRef] [PubMed]
Teyhen, D. S., Flynn, T. W., Childs, J. D., Kuklo, T. R., Rosner, M. K., Polly, D. W., and Abraham, L. D., 2007, “Fluoroscopic Video to Identify Aberrant Lumbar Motion,” Spine, 32(7), pp. E220–E229. [CrossRef] [PubMed]
Ahmadi, A., Maroufi, N., Behtash, H., Zekavat, H., and Parnianpour, M., 2009, “Kinematic Analysis of Dynamic Lumbar Motion in Patients With Lumbar Segmental Instability Using Digital Videofluoroscopy,” Eur. Spine J., 18(11), pp. 1677–1685. [CrossRef] [PubMed]
Cerciello, T., Romano, M., Bifulco, P., Cesarelli, M., and Allen, R., 2011, “Advanced Template Matching Method for Estimation of Intervertebral Kinematics of Lumbar Spine,” Med. Eng. Phys., 33(10), pp. 1293–1302. [CrossRef] [PubMed]
Panjabi, M., Chang, D., and Dvorak, J., 1992, “An Analysis of Errors in Kinematic Parameters Associated With in Vivo Functional Radiographs,” Spine, 17(2), pp. 200–205. [CrossRef] [PubMed]
Tashman, S., 2008, “Comments on Validation of a Non-Invasive Fluoroscopic Imaging Technique for the Measurement of Dynamic Knee Joint Motion,” J. Biomech., 41(15), p. 3290. [CrossRef] [PubMed]
Anderst, W., Zauel, R., Bishop, J., Demps, E., and Tashman, S., 2009, “Validation of Three-Dimensional Model-Based Tibio-Femoral Tracking During Running,” Med. Eng. Phys., 31(1), pp. 10–16. [CrossRef] [PubMed]
Bey, M. J., Zauel, R., Brock, S. K., and Tashman, S., 2006, “Validation of a New Model-Based Tracking Technique for Measuring Three-Dimensional, in Vivo Glenohumeral Joint Kinematics,” ASME J. Biomech. Eng., 128(4), pp. 604–609. [CrossRef]
Anderst, W. J., Baillargeon, E., Donaldson, W. F.3rd, Lee, J. Y., and Kang, J. D., 2011, “Validation of a Noninvasive Technique to Precisely Measure in Vivo Three-Dimensional Cervical Spine Movement,” Spine, 36(6), pp. E393–E400. [CrossRef] [PubMed]
Wilke, H. J., Neef, P., Caimi, M., Hoogland, T., and Claes, L. E., 1999, “New in Vivo Measurements of Pressures in the Intervertebral Disc in Daily Life,” Spine, 24(8), pp. 755–762. [CrossRef] [PubMed]
Della Croce, U., Leardini, A., Chiari, L., and Cappozzo, A., 2005, “Human Movement Analysis Using Stereophotogrammetry. Part 4: Assessment of Anatomical Landmark Misplacement and Its Effects on Joint Kinematics,” Gait Posture, 21(2), pp. 226–237. [CrossRef] [PubMed]
Martin, D. E., Greco, N. J., Klatt, B. A., Wright, V. J., Anderst, W. J., and Tashman, S., 2011, “Model-Based Tracking of the Hip: Implications for Novel Analyses of Hip Pathology,” J. Arthroplasty, 26(1), pp. 88–97. [CrossRef] [PubMed]
Wu, G., Siegler, S., Allard, P., Kirtley, C., Leardini, A., Rosenbaum, D., Whittle, M., D'Lima, D. D., Cristofolini, L., Witte, H., Schmid, O., Stokes, I., and Terminology Committee of the International Society of Standardization B, 2002, “ISB Recommendation on Definitions of Joint Coordinate System of Various Joints for the Reporting of Human Joint Motion—Part I: Ankle, Hip, and Spine. International Society of Biomechanics,” J. Biomech., 35(4), pp. 543–548. [CrossRef] [PubMed]
Kane, T. L. P., and LevinsonD., 1983, Spacecraft Dynamics, McGraw-Hill, New York
Bey, M. J., Kline, S. K., Tashman, S., and Zauel, R., 2008, “Accuracy of Biplane X-Ray Imaging Combined With Model-Based Tracking for Measuring In-Vivo Patellofemoral Joint Motion,” J. Orthop. Surg. Res., 3, p. 38. [CrossRef] [PubMed]
Lee, J. B. E., and Anderst, W. J., 2010, “Lumbar Spine Motion During Functional Movement: in Vivo Validation of Flexion/Extension Movement Tracking,” 3rd Annual Lumbar Spine Research Society Meeting, Chicago, IL.
Schauer, D. A., and Linton, O. W., 2009, “NCRP Report No. 160, Ionizing Radiation Exposure of the Population of the United States, Medical Exposure—Are We Doing Less With More, and Is There a Role for Health Physicists?,” Health Phys., 97(1), pp. 1–5. [CrossRef] [PubMed]
Christner, J. A., Kofler, J. M., and McCollough, C. H., 2010, “Estimating Effective Dose for CT Using Dose-Length Product Compared With Using Organ Doses: Consequences of Adopting International Commission on Radiological Protection Publication 103 or Dual-Energy Scanning,” Am. J. Roentgenol., 194(4), pp. 881–889. [CrossRef]
Wong, T. K., and Lee, R. Y., 2004, “Effects of Low Back Pain on the Relationship Between the Movements of the Lumbar Spine and Hip,” Human Movement Sci., 23(1), pp. 21–34. [CrossRef]
Lee, R. Y., and Wong, T. K., 2002, “Relationship Between the Movements of the Lumbar Spine And Hip,” Human Movement Sci., 21(4), pp. 481–494. [CrossRef]
Haque, M. A., Anderst, W., Tashman, S., and Marai, G. E., 2013, “Hierarchical Model-Based Tracking of Cervical Vertebrae From Dynamic Biplane Radiographs,” Med. Eng. Phys., 35(7), pp. 994–1004. [CrossRef] [PubMed]
Lee, S. W., Wong, K. W., Chan, M. K., Yeung, H. M., Chiu, J. L., and Leong, J. C., 2002, “Development and Validation of a New Technique for Assessing Lumbar Spine Motion,” Spine, 27(8), pp. E215–E220. [CrossRef] [PubMed]
O'Reilly, O. M., Metzger, M. F., Buckley, J. M., Moody, D. A., and Lotz, J. C., 2009, “On the Stiffness Matrix of the Intervertebral Joint: Application to Total Disk Replacement,” ASME J. Biomech. Eng., 131(8), p. 081007. [CrossRef]
Stokes, I. A., Gardner-Morse, M., Churchill, D., and Laible, J. P., 2002, “Measurement of a Spinal Motion Segment Stiffness Matrix,” J. Biomech., 35(4), pp. 517–521. [CrossRef] [PubMed]
Gardner-Morse, M. G., and Stokes, I. A., 2004, “Structural Behavior of Human Lumbar Spinal Motion Segments,” J. Biomech., 37(2), pp. 205–212. [CrossRef] [PubMed]
Stokes, I. A., and Gardner-Morse, M., 1995, “Lumbar Spine Maximum Efforts and Muscle Recruitment Patterns Predicted by a Model With Multijoint Muscles and Joints With Stiffness,” J. Biomech., 28(2), pp. 173–186. [CrossRef] [PubMed]
Stokes, I. A., and Gardner-Morse, M., 2001, “Lumbar Spinal Muscle Activation Synergies Predicted by Multi-Criteria Cost Function,” J. Biomech., 34(6), pp. 733–740. [CrossRef] [PubMed]
Huynh, K. T., Lu, I. G. W. F., and Jagdish, B. N., 2010, “Simulating Dynamics of Thoracolumbar Spine Derived From LifeMOD Under Haptic Forces,” World Acad. Sci. Eng. Technol., 64, pp. 278–285.
Abouhossein, A., Weisse, B., and Ferguson, S. J., 2011, “A Multibody Modelling Approach to Determine Load Sharing Between Passive Elements of the Lumbar Spine,” Comput. Methods Biomech. Biomed. Eng., 14(6), pp. 527–537. [CrossRef]
Han, K. S., Zander, T., Taylor, W. R., and Rohlmann, A., 2012, “An Enhanced and Validated Generic Thoraco-Lumbar Spine Model for Prediction of Muscle Forces,” Med. Eng. Phys., 34(6), pp. 709–716. [CrossRef] [PubMed]


Grahic Jump Location
Fig. 1

(a) Dynamic stereo radiography (DSX) system configured for the functional lifting task. (b) Lateral view shows positioning of the pelvic rest and radiation attenuator. (c) and (d) Illustration of the radiation attenuator.

Grahic Jump Location
Fig. 2

Graphical representation of the volumetric model-based bone tracking process

Grahic Jump Location
Fig. 3

Vertebral anatomical coordinate system with origin located at the center of the vertebral body. Origin is defined as the mean of the eight landmark (red) points. Axis1 is defined as the vector connecting the anterior and posterior points on the superior endplate. Temporary axis is defined as the vector connecting the two lateral points. Vertical axis (Axis2) is defined as the cross product (Axis1 × temporary axis). Axis3 is then defined as the cross product (Axis1 × Axis2).

Grahic Jump Location
Fig. 4

Continuous extension (ad) and AP translation (eh) data for individual participants during the lifting task. Intervertebral segmental motion is plotted against L2–S1 ROM. Each participant's L2–S1 ROM is normalized to the upright posture recorded during the static test (100%), with the initial position in the lifting task set as 0%.

Grahic Jump Location
Fig. 5

Segmental distribution of L2–S1 rotation (a) and translation (b). Bars delineate the percentage contribution from each lumbar segment to the overall L2–S1 motion at every 10th percent of L2–S1 rotation during the functional lifting task. 100% motion is defined as the L2–S1 pose in the static upright posture. 0% is the initial position at the beginning of the lifting task. Error bars are 95% confidence intervals.

Grahic Jump Location
Fig. 6

Slope of the segmental rotation with respect to the overall lumbar (L2–S1) extension, shown for each segment. L2–S1 extension is normalized to the upright static posture (100%), with the initial position set as 0%. Slopes are calculated based on linear fit to the data between 20% and 80% of the overall lumbar motion. Error bars are 95% confidence intervals. No statistical differences were detected in the slope means between the segments by ANOVA (p = 0.4).



Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging and repositioning the boxes below.

Related Journal Articles
Related eBook Content
Topic Collections

Sorry! You do not have access to this content. For assistance or to subscribe, please contact us:

  • TELEPHONE: 1-800-843-2763 (Toll-free in the USA)
  • EMAIL: asmedigitalcollection@asme.org
Sign In