Kinematics of the cervical spine in lateral bending in vivo three-dimensional analysis

Study Design. Kinematics of the cervical spine during lateral bending were investigated using a novel system of three-dimensional motion analysis. Objectives. To demonstrate in vivo intervertebral coupled motions of the cervical spine during lateral bending of the neck. Summary of Background Data. No previous studies have successfully documented in vivo three-dimensional intervertebral motions of the cervical spine during lateral bending. Methods. Twelve healthy volunteers underwent three-dimensional magnetic resonance imaging (MRI) of the cervical spine in 7 positions with 10 increments of lateral bending. Relative motions of the cervical spine were calculated automatically by superimposing a segmented three-dimensional-MRI of the vertebra in the neutral position over images of each position using volume registration. Results. Mean maximum lateral bending of the cervical spine to one side was 1.6 to 5.7 at each level. Coupled axial rotation opposite to lateral bending was observed in the upper cervical levels (Oc - C1, 0.2 degrees; C1 - C2, 17.1 degrees), while in the subaxial cervical levels, it was observed in the same direction as lateral bending except for at C7 - T1. Coupled flexion-extension motion was small at all vertebral levels ( < 1.1 degrees). Conclusions. We succeeded in identifying in vivo coupled motions of the cervical spine in lateral bending for the first time.