Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Dec;50(12):1705-1733.
doi: 10.1007/s10439-022-03088-8. Epub 2022 Dec 10.

Kinematics of the Cervical Spine Under Healthy and Degenerative Conditions: A Systematic Review

Affiliations
Review

Kinematics of the Cervical Spine Under Healthy and Degenerative Conditions: A Systematic Review

Sara Lindenmann et al. Ann Biomed Eng. 2022 Dec.

Abstract

Knowledge of spinal kinematics is essential for the diagnosis and management of spinal diseases. Distinguishing between physiological and pathological motion patterns can help diagnose these diseases, plan surgical interventions and improve relevant tools and software. During the last decades, numerous studies based on diverse methodologies attempted to elucidate spinal mobility in different planes of motion. The authors aimed to summarize and compare the evidence about cervical spine kinematics under healthy and degenerative conditions. This includes an illustrated description of the spectrum of physiological cervical spine kinematics, followed by a comparable presentation of kinematics of the degenerative cervical spine. Data was obtained through a systematic MEDLINE search including studies on angular/translational segmental motion contribution, range of motion, coupling and center of rotation. As far as the degenerative conditions are concerned, kinematic data regarding disc degeneration and spondylolisthesis were available. Although the majority of the studies identified repeating motion patterns for most motion planes, discrepancies associated with limited sample sizes and different imaging techniques and/or spine configurations, were noted. Among healthy/asymptomatic individuals, flexion extension (FE) and lateral bending (LB) are mainly facilitated by the subaxial cervical spine. C4-C5 and C5-C6 were the major FE contributors in the reported studies, exceeding the motion contribution of sub-adjacent segments. Axial rotation (AR) greatly depends on C1-C2. FE range of motion (ROM) is distributed between the atlantoaxial and subaxial segments, while AR ROM stems mainly from the former and LB ROM from the latter. In coupled motion rotation is quantitatively predominant over translation. Motion migrates caudally from C1-C2 and the center of rotation (COR) translocates anteriorly and superiorly for each successive subaxial segment. In degenerative settings, concurrent or subsequent lesions render the association between diseases and mobility alterations challenging. The affected segments seem to maintain translational and angular motion in early and moderate degeneration. However, the progression of degeneration restrains mobility, which seems to be maintained or compensated by adjacent non-affected segments. While the kinematics of the healthy cervical spine have been addressed by multiple studies, the entire nosological and kinematic spectrum of cervical spine degeneration is partially addressed. Large-scale in vivo studies can complement the existing evidence, cover the gaps and pave the way to technological and clinical breakthroughs.

Keywords: Axial rotation; Center of rotation; Extension; Flexion; Lateral bending; Motion; Range of motion.

PubMed Disclaimer

Conflict of interest statement

Prof. M. Farshad possesses stocks in two biomedical startup companies (Incremed Balgrist University, 25Segments Balgrist University), is a board member of Swiss Orthopaedics and has filled a number of patents related to spine surgery instrumentation. Details have been disclosed in a designated Conflict-of-Interest (COI) form during submission. The remaining authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Angular contribution of the segments Occ-Th1. (a) Flexion/Extension; (b) Lateral Bending; (c) Axial Rotation. Dashed lines are used when the values for certain levels were not available and an average value from the other studies was used. Studies conducted in a supine position of the subjects are marked in red.
Figure 2
Figure 2
Maximal angular ROM for each cervical segment between Occ-Th1 expressed in [°]. (a) Flexion/Extension; (b) Lateral Bending; (c) Axial Rotation. For every segment the mean, SD, median and IQR were calculated based on the available values. Error bars represent the standard deviation (error data was not available for data from Anderst et al. 2015, LeVasseur et al. and Iai et al.).
Figure 3
Figure 3
Coupled rotational motion (as ratio [%] of the maximal ROM of the primary motion). (a) Coupled rotational motion during flexion/extension; (b) Coupled rotational motion during lateral bending; (c) Coupled rotational motion during axial rotation. Values exceeding 100% are larger than the movement in the primary direction.
Figure 4
Figure 4
Coupled translational motion in anterior–posterior (AP), superior-inferior (SI) and medial–lateral (ML) direction (expressed in mm). (a) Coupled translational motion during flexion/extension; (b) Coupled translational motion during lateral bending; (c) Coupled translational motion during axial rotation.
Figure 5
Figure 5
Center of rotation as observed in studies involving healthy participants and providing data eligible for inclusion in a figure.
Figure 6
Figure 6
Portion [%] of segmental instability based on the grade of disc degeneration in the intervertebral levels C3–C7. Cervical segmental instability was considered when the sagittal plane displacement between two cervical vertebrae was more than 3.5 mm or the relative sagittal plane angulation was greater than 11°. The illustrated data is from Dai et al. and comply with the five-grade DD scale of Mehalic et al.
Figure 7
Figure 7
Angular motion (a) and translational motion (b) contribution for Flexion–Extension in relation to the degree of disc degeneration according to the data by Miyazaki et al. They used their own DD grading system with five levels of disc degeneration. Motion contribution is expressed in % to the total motion from C2 to C7 and C2 to Th1 respectively. (c) Angular motion contribution (in % to the total motion from C3–C7) for Flexion–Extension in relation to the degree of disc degeneration according to the data by Morishita et al. They used their own DD grading system with three levels of disc degeneration. I, II and III correspond to the level of cervical cord compression defined by Morishita et al. All the measurements are normalized to 100% to make comparison easier. For instance, angular motion contribution of 130% for C4–C5, implies that the segment contributes 30% more than expected in its healthy configuration.
Figure 8
Figure 8
Rotational motion (a) and translational motion (b) for all types of degenerative cervical spondylolisthesis (DCS) or specified into anterolisthesis and retrolisthesis on the cephalad, listhesis or caudal level. No spondylolisthesis (No SL) corresponds to the average physiological ROM at C4–C6 segments as described in Fig. 2a. Those levels correspond to the levels with the highest frequency of disc degeneration. All illustrated data is from Paholpak et al.
Figure 9
Figure 9
Search strategy for studies on segmental contribution in the cervical spine.
Figure 10
Figure 10
Literature search for studies on maximal ROM of the cervical spine.
Figure 11
Figure 11
Literature search for studies on coupled angular motion and translation in the cervical spine.
Figure 12
Figure 12
Literature search for studies on the center of rotation in the cervical spine.
Figure 13
Figure 13
Literature search for studies on phase lag in the cervical spine.
Figure 14
Figure 14
Literature search for studies on mechanical stiffness in cervical DD.
Figure 15
Figure 15
Literature search for studies on segmental and overall ROM in cervical DD.
Figure 16
Figure 16
Literature search for studies on center of rotation in cervical DD.
Figure 17
Figure 17
Literature search for studies on the effect of spondylolisthesis on the kinematics of the cervical spine.

Similar articles

Cited by

References

    1. 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) 1991;6:111–117. doi: 10.1016/0268-0033(91)90008-E. - DOI - PubMed
    1. Anderst W., E. Baillargeon, W. Donaldson, J. Lee and J. Kang. Motion path of the instant center of rotation in the cervical spine during in vivo dynamic flexion-extension: implications for artificial disc design and evaluation of motion quality after arthrodesis. Spine (Phila Pa 1976) 38: E594–601, 2013. - PMC - PubMed
    1. Anderst W. J., W. F. Donaldson, 3rd, J. Y. Lee and J. D. Kang. Cervical motion segment percent contributions to flexion-extension during continuous functional movement in control subjects and arthrodesis patients. Spine (Phila Pa 1976) 38: E533–539, 2013. - PMC - PubMed
    1. Anderst WJ, Donaldson WF, Lee JY, Kang JD. Cervical spine intervertebral kinematics with respect to the head are different during flexion and extension motions. J. Biomech. 2013;46:1471–1475. doi: 10.1016/j.jbiomech.2013.03.004. - DOI - PMC - PubMed
    1. Anderst WJ, Donaldson WF, Lee JY, Kang JD. Subject-specific inverse dynamics of the head and cervical spine during in vivo dynamic flexion-extension. J. Biomech. Eng. 2013;135:61007–61008. doi: 10.1115/1.4023524. - DOI - PMC - PubMed

MeSH terms