Sagittal range of motion of the thoracic spine using standing digital radiography: A throughout comparison with non-radiographic data reviewed from the literature

Document Type : Article


Department of Mechanical Engineering, Sharif University of Technology, Tehran, P.O. Box 11155-9567, Iran.


Previous studies have measured thoracic range of motion (RoM) using either skin-mounted devices or supine CT-imaging and have reported quite different RoMs. Given the inherent shortcomings of measurements of vertebrae movements from the overlying skin, the present study aims to measure normal RoM of the thoracic spine in the sagittal plane using the upright digital radiography. Lateral radiographs of the thoracic spine were acquired from eight asymptomatic male subjects in upright standing and full forward flexion using a mobile U-arm digital radiographic system. Total (T1-T12), upper (T1-T6), and lower (T6-T12) thoracic RoMs were measured. A throughout comparison with available skin-based measurements in the literature was carried out. Mean of total (T1-T12) thoracic RoM was 22.5° (SD 4.1°), most of which was generated by the lower (T6-T12) as compared to upper (T1-T6) thoracic spine (15.5° versus 7.1°, p measurements suffer from the inter sensor-skin-vertebra movements and supine imaging techniques do not allow maximal trunk flexion, standing radiography remains as the gold-standard technique. Evaluation of thoracic spine RoM has implications in both patient discrimination for diagnosis and in biomechanical models for estimation of spinal loads


Main Subjects

1. Briggs, A.M., Bragge, P., Smith, A.J., Govil, D., and Straker, L.M. Prevalence and associated factors for thoracic spine pain in the adult working population: a literature review", Journal of Occupational Health, 51(3), pp. 177-192 (2009). 2. Fouquet, N., Bodin, J., Descatha, A., Petit, A., Ramond-Roquin, A., Ha, C., and Roquelaure, Y. 188 thoracic spinal pain prevalence in the musculoskeletal disorders surveillance network of the French Pays de la Loire region", Occupational and Environmental Medicine, 71(Suppl 1), pp. A24-A24 (2014). 3. Fouquet, N., Bodin, J., Descatha, A., Petit, A., Ramond, A., Ha, C., and Roquelaure, Y. Prevalence of thoracic spine pain in a surveillance network", Occupational Medicine, 65(2), pp. 122-125 (2015). 4. Nohara, Y., Taneichi, H., Ueyama, K., Kawahara, N., Shiba, K., Tokuhashil, Y., Tani, T., Nakahara, S., and Iida, T. Nationwide survey on complications of spine surgery in Japan", Journal of Orthopaedic Science, 9(5), pp. 424-433 (2004). 5. Theisen, C., van Wagensveld, A., Timmesfeld, N., Efe, T., Heyse, T.J., Fuchs-Winkelmann, S., and Schofer, M.D. Co-occurrence of outlet impingement syndrome of the shoulder and restricted range of motion in the thoracic spine - a prospective study with ultrasoundbased motion analysis", BMC Musculoskeletal Disorders, 11(1), p. 1 (2010). 6. Arjmand, N. and Shirazi-Adl, A. Model and in vivo studies on human trunk load partitioning and stability in isometric forward exions", Journal of Biomechanics, 39(3), pp. 510-521 (2006). 7. Arjmand, N., Plamondon, A., Shirazi-Adl, A., Lariviere, C., and Parnianpour, M. Predictive equations to estimate spinal loads in symmetric lifting tasks", Journal of Biomechanics, 44(1), pp. 84-91 (2011). 8. Arjmand, N., Plamondon, A., Shirazi-Adl, A., Parnianpour, M., and Larivi_ere, C. Predictive equations for lumbar spine loads in load-dependent asymmetric one-and two-handed lifting activities", Clinical Biomechanics, 27(6), pp. 537-544 (2012). 9. Tully, E.A. and Stillman, B.C. Computer-aided video analysis of vertebrofemoral motion during toe touching in healthy subjects", Archives of Physical Medicine and Rehabilitation, 78(7), pp. 759-766 (1997). 10. Mannion, A.F., Knecht, K., Balaban, G., Dvorak, J., and Grob, D. A new skin-surface device for measuring the curvature and global and segmental ranges of motion of the spine: reliability of measurements and comparison with data reviewed from the literature", European Spine Journal, 13(2), pp. 122-136 (2004). 11. Troke, M., Moore, A.P., and Cheek, E. Reliability of the OSI CA 6000 spine motion analyzer with a new skin _xation system when used on the thoracic spine", Manual Therapy, 3(1), pp. 27-33 (1998). 12. Hsu, C.J., Chang, Y.W., Chou, W.Y., Chiou, C.P., Chang, W.N., andWong, C.Y. Measurement of spinal range of motion in healthy individuals using an electromagnetic tracking device", Journal of Neurosurgery: Spine, 8(2), pp. 135-142 (2008). 13. Willems, J.M., Jull, G.A., and Ng, J.F. An in vivo study of the primary and coupled rotations of the thoracic spine", Clinical Biomechanics, 11(6), pp. 311- 316 (1996). 14. Hajibozorgi, M. and Arjmand, N. Sagittal range of motion of the thoracic spine using inertial tracking device and e_ect of measurement errors on model predictions", Journal of Biomechanics, 49(6), pp. 913- 918 (2016). 15. White III, A.A., Panjabi, M.M., Clinical Biomechanics of the Spine, 2nd Ed. pp. 102-103, Lippincott, Philadelphia, US (1990). 16. Morita, D., Yukawa, Y., Nakashima, H., Ito, K., Yoshida, G., Machino, M., Kanbara, S., Iwase, T., and Kato, F. Range of motion of thoracic spine in sagittal plane", European Spine Journal, 23(3), pp. 673-678 (2014). 17. O'gorman, H. and Jull, G. Thoracic kyphosis and mobility: the e_ect of age", Physiotherapy Practice, 3(4), pp. 154-162 (1987). 18. Brinckmann, P., Frobin, W., Biggemann, M., Hilweg, D., Seidel, S., Burton, K., Tillotson, M., Sandover, J., Atha, J., Quinnell, R., and Chiropractic, A.E.C. Quanti_cation of overload injuries to thoracolumbar vertebrae and discs in persons exposed to heavy physical exertions or vibration at the work-place: the shape of vertebrae and intervertebral discs-study of a young, healthy population and a middle-aged control group", Clinical Biomechanics, 9, pp. S3-S83 (1994). 19. Frobin, W., Brinckmann, P., Leivseth, G., Biggemann, M., and Reiker_as, O. Precision measurement of segmental motion from exion-extension radiographs of the lumbar spine", Clinical Biomechanics, 11(8), pp. 457-465 (1996). 20. Briggs, A.M., Wrigley, T.V., Tully, E.A., Adams, P.E., Greig, A.M., and Bennell, K.L. Radiographic measures of thoracic kyphosis in osteoporosis: Cobb and vertebral centroid angles", Skeletal Radiology, 36(8), pp. 761-767 (2007). 21. Harrison, D.E., Harrison, D.D., Cailliet, R., Janik, T.J., and Holland, B. Radiographic analysis of lumbar lordosis: centroid, Cobb, TRALL, and Harrison posterior tangent methods", Spine, 26(11), pp. e235-e242 (2001). 22. Bernhardt, M. and Bridwell, K.H. Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction", Spine, 14(7), pp. 717-721 (1989). 23. Edmondston, S.J., Christensen, M.M., Keller, S., Steigen, L.B., and Barclay, L. Functional radiographic analysis of thoracic spine extension motion in asymptomatic men", Journal of Manipulative and Physiological Therapeutics, 35(3), pp. 203-208 (2012). 24. Gangnet, N., Dumas, R., Pomero, V., Mitulescu, A., Skalli, W., and Vital, J.M. Three-dimensional spinal and pelvic alignment in an asymptomatic population", Spine, 31(15), pp. E507-E512 (2006). 25. Gelb, D.E., Lenke, L.G., Bridwell, K.H., Blanke, K. and McEnery, K.W. An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers", Spine, 20(12), pp. 1351-1358 (1995). 26. Harrison, D.E., Cailliet, R., Harrison, D.D., and Janik, T.J. How do anterior/posterior translations of the thoracic cage a_ect the sagittal lumbar spine, pelvic tilt, and thoracic kyphosis?", European Spine Journal, 11(3), pp. 287-293 (2002). 27. Jackson, R.P. and McManus, A.C. Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size: A prospective controlled clinical study", Spine, 19(14), pp. 1611-1618 (1994). 28. Janssen, M.M., Vincken, K.L., van Raak, S.M., Vrtovec, T., Kemp, B., Viergever, M.A., Bartels, L.W., and Castelein, R.M. Sagittal spinal pro_le and spinopelvic balance in parents of scoliotic children", The Spine Journal, 13(12), pp. 1789-1800 (2013). 29. Vaz, G., Roussouly, P., Berthonnaud, E., and Dimnet, J. Sagittal morphology and equilibrium of pelvis and spine", European Spine Journal, 11(1), pp. 80-87 (2002). 30. Vedantam, R., Lenke, L.G., Keeney, J.A., and Bridwell, K.H. Comparison of standing sagittal spinal alignment in asymptomatic adolescents and adults", Spine, 23(2), pp. 211-215 (1998). 31. Vialle, R., Levassor, N., Rillardon, L., Templier, A., Skalli, W., and Guigui, P. Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects", The Journal of Bone & Joint Surgery, 87(2), pp. 260-267 (2005). 32. Perriman, D.M., Scarvell, J.M., Hughes, A.R., Ashman, B., Lueck, C.J., and Smith, P.N. Validation of the exible electrogoniometer for measuring thoracic kyphosis", Spine, 35(14), pp. E633-E640 (2010). 33. Goh, S., Price, R.I., Leedman, P.J., and Singer, K.P. A comparison of three methods for measuring thoracic kyphosis: implications for clinical studies", Rheumatology, 39(3), pp. 310-315 (2000). 34. Johnson, K.D., Kim, K.M., Yu, B.K., Saliba, S.A., and Grindsta_, T.L. Reliability of thoracic spine rotation range-of-motion measurements in healthy adults", Journal of Athletic Training, 47(1), pp. 52-60 (2012). 35. Gercek, E., Hartmann, F., Kuhn, S., Degreif, J., Rommens, P.M., and Rudig, L. Dynamic angular three-dimensional measurement of multisegmental thoracolumbar motion in vivo", Spine, 33(21), pp. 2326- 2333 (2008). 36. Voutsinas, S.A. and MacEwen, G.D. Sagittal pro_les of the spine", Clinical Orthopaedics and Related Research, 210, pp. 235-242 (1986). 37. Bradford, D.S., Moe, J.H., and Winter, R.B. Kyphosis and postural roundback deformity in children and adolescents", Minnesota Medicine, 56(2), pp. 114-120 (1973). 38. Fon, G.T., Pitt, M.J., and Thies Jr, A.C. Thoracic kyphosis: range in normal subjects", American Journal of Roentgenology, 134(5), pp. 979-983 (1980). 39. Pearcy, M., Portek, I., and Shephard, J. Threedimensional x-ray analysis of normal movement in the lumbar spine", Spine, 9(3), pp. 294-297 (1984). 40. Ignasiak, D., Ferguson, S.J., and Arjmand, N. A rigid thorax assumption a_ects model loading predictions at the upper but not lower lumbar levels", Journal of Biomechanics, 49(13), pp. 3074-3078 (2016).