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Biomedical subjects

D D Harrison

Publications and source records attributed to D D Harrison.

At least 37 records · Page 2Linked to original sources
PubMed1999

Low back pain and the lumbar intervertebral disk: clinical considerations for the doctor of chiropractic.

BACKGROUND: Low back pain exists in epidemic proportions in the United States. Studies that demonstrate innervation to the intervertebral disk provide evidence that may account for instances of discogenic low back pain encountered in general medical and chiropractic practice. Many patients and health care practitioners believe that intervertebral disk lesions require surgery as the only method of treatment that will result in satisfactory outcome. Surgery rates vary widely across geographic regions. Only one randomized prospective study exists that compares surgical and nonsurgical treatment; it demonstrated essentially equal outcomes in the long run. OBJECTIVE: To review specific aspects of the examination, history, imaging, and treatment of patients with suspected intervertebral disk lesions and to provide guidelines for conservative management, imaging, and relative and absolute indications for surgical referral. DATA SOURCES: Review articles, texts, and original articles from indexed refereed sources that discuss the lumbar intervertebral disk in regard to patient history, physical examination, imaging, treatment, and referral for surgery. RESULTS: Patients with low back pain who do not present with so-called red flags (fever, history of cancer, unexplained weight loss, urinary tract infection, intravenous drug use, saddle anesthesia, or prolonged use of corticosteroids) may be treated initially with conservative methods. Imaging studies are helpful in determining the patient's diagnosis, and computed tomography, magnetic resonance imaging, or other special imaging studies should be ordered judiciously. The only prospective, randomized study of conservative versus surgical management of herniated lumbar intervertebral disk lesions indicates both methods provide adequate outcome in the long run. Little consensus exists on the best method of management for patients with intervertebral disk lesions without absolute indications for surgery. CONCLUSION: Patients should be screened for "red flags" to determine whether they are candidates for conservative treatment. Magnetic resonance imaging is perhaps the most practical imaging study for evaluation of lumbar disk lesions because it involves no use of ionizing radiation and because magnetic resonance imaging has other advantages over computed tomographic scanning such as excellent delineation of soft tissue structures, direct multiplanar imaging, and excellent characterization of medullary bone. Provocation computed tomography-diskography is an invasive procedure and should be reserved for patients with normal magnetic resonance imaging findings and continuing severe pain who have not been helped by conservative treatment attempts and for whom surgical intervention is contemplated. Both conservative and surgical interventions have been shown to be effective in the treatment of discogenic and radicular pain syndromes.

Chiropractic↗
PubMed1999

Lumbar coupling during lateral translations of the thoracic cage relative to a fixed pelvis.

OBJECTIVE: To determine lumbar coupling during lateral postural translations (lumbosacral list) of the thoracic cage relative to a fixed pelvis. DESIGN: Digitized measurements from anteroposterior lumbar radiographs of 17 volunteers were obtained in neutral, maximal left lateral translation and maximal right lateral translation posture of the thoracic cage compared to a fixed pelvis. Subjects were constrained with two sets of clamps at the lateral borders of the pelvis and lower ribs. BACKGROUND: Data. Clinically, lumbosacral list is a common posture. Range of motion and spinal coupling results have not been reported for the lumbosacral list movement. METHODS: Four vertebral body corners, mid narrow-waisted body margins, superior and inferior pedicle margins, and spinous-lamina junction of T12-L5 were digitized on 51 anterior-posterior lumbar radiographs. Using the orthogonal axes of positive x-direction to the left, vertical as positive y, and anterior as positive z, digitized points were used to measure projected segmental z-axis rotation, y-axis rotation, and segmental lateral translations of each vertebra. RESULTS: Using the displacement of T12, subjects could translate 35-70 mm left or right along the x-axis with an average of 53.2 mm to the left and 52.1 mm to the right. Using superior endplates to superior sacral base, lateral flexion was largest at L1 and decreased from L1 to L5, but the segmental rotation angles for lateral flexion were largest at L2-L3 (3.9 degrees ), L3-L4 (6.2 degrees ) and L4-L5 (5.7 degrees ) and were in the same direction as the main motion translation. The relative z-axis rotation of T12 was opposite to the direction of L1-L5. The coupled y-axis rotations were less than 1 degrees and coupled segmental lateral translations were averaging less than 1 mm. CONCLUSIONS: Thoracic cage x-axis translations compared to a fixed pelvis are significant, between 35 and 70 mm. The z-axis lumbar coupled rotation was largest at L2-L3, L3-L4 and L4-L5 and to the same side of the main motion translation in L1-L5, but opposite the main motion direction for T12. All other movements were small, averaging less than 1 degrees or 1 mm. RELEVANCE: The clinically common posture of lateral translation of the thoracic cage (lumbosacral list) is often associated with disc herniation. Yet normal lumbar coupling patterns and total range of motion of this movement have not been established in the literature. Normal values for lumbar segmental coupling on anterior-posterior lumbo-pelvic radiographs during trunk list might be important for an analysis of segmental instability since segmental translations were determined to be 1 mm or less.

Adult↗
PubMed1998

Safety of the maternal-infant zidovudine regimen utilized in the Pediatric AIDS Clinical Trial Group 076 Study.

OBJECTIVE: To determine the safety of the zidovudine (ZDV) regimen utilized in the Pediatric AIDS Clinical Trial Group (ACTG) 076 study. DESIGN: ACTG 076 was a randomized, double-blind, placebo-controlled trial which demonstrated that a ZDV regimen could prevent mother-to-child HIV-1 transmission. Infants were followed through 18 months of age and women were followed through 6 months postpartum. METHODS: Maternal complications, pregnancy outcomes, growth and development of the uninfected infants, and HIV-1 disease progression in the women were monitored prospectively. RESULTS: Maternal therapy was well tolerated. There was no serious pattern of adverse pregnancy outcomes associated with ZDV use. Amongst the ZDV-exposed infants, the only recognized toxicity was anemia within the first 6 weeks of life; the risk for anemia was not associated with premature delivery, duration of maternal treatment, degree of maternal immunosuppression, or maternal anemia. ZDV treatment was not associated with an increased incidence of newborn structural abnormalities. At 18 months of age, uninfected infants did not differ in growth parameters or immune function. No childhood neoplasias were reported in either group. In the women, at 6 months postpartum, there were no differences in clinical, immunologic, or virologic disease progression. CONCLUSION: There were no identified problems that would alter current recommendations for the routine use of ZDV for the prevention of mother-child HIV-1 transmission.

Anti-HIV Agents↗
PubMed1998

Can the sagittal lumbar curvature be closely approximated by an ellipse?

For the sagittal lumbar curvature, existing spinal models are based only on the anthropomorphic radiographic characteristics of one individual, or, at best, of only a few individuals. This raises questions of applicability of the modeling results to clinical situations. Because spinal coupling and loads on spinal tissues have been shown to be functions of the initial static posture, a rigorously derived neutral lumbar lordosis would be important for clinicians and spine researchers. This study presents modeling of the sagittal lumbar spine in the shape of an ellipse. Vertebral body and disc heights, derived from digitized lateral lumbar radiographs of 50 normal subjects, were used to create an ellipse along the posterior body margins from the inferior of T12 to the superior sacral base. Additional data to create an elliptical lumbar model were determined from a least-squares analysis of passing ellipses through the digitized posterior body points. This confirmed that an elliptical model closely fit the lumbar curvature with a least-squares error of 1.2 mm per digitized point. The elliptical model is approximately an 85 degrees portion of a quadrant. The semi-major and semi-minor axes, a and b, are parallel to the posterior body margin of T12 and parallel to the inferior body endplate of T12, respectively, with a semi-minor to semi-major radio of b/a=0.39. The elliptic model has a height-to-length ratio of H/L=0.963, where height is the vertical distance from inferior T12 to superior S1 and length is the arc length along George's line (along the posterior longitudinal ligament) from T12 to S1.

Adult↗
PubMed1998

Structural rehabilitation of the spine and posture: rationale for treatment beyond the resolution of symptoms.

OBJECTIVE: To provide a rationale for active chiropractic rehabilitative treatment that extends beyond the single goal of resolution of symptomatic complaints. DATA COLLECTION: A manual search of available reference texts and a search of MEDLINE were collected with an emphasis on tissue healing sequelae and the role of mechanical loading on this process. RESULTS: The reviewed material indicates that all tissue growth and repair is influenced by mechanical loading and body posture and is positively affected by body postures that normalize/minimize adverse mechanical stresses and strains. Altered alignment of the human frame may lead to poor healing of the body tissues and eventual pathological architectural changes may occur in muscle, ligament, bone and central nervous system. Minimization of altered postural/structural loading of the human frame may take longer than resolution, or maximal reduction, of offensive symptoms. By itself, a patient's perception of pain is not a valid indicator of health. CONCLUSION: Because mechanical loading of the neuromusculoskeletal tissues plays a vital role in influencing proper growth and repair, chiropractic rehabilitative care should focus on the normalization/minimization of aberrant stresses and strains acting on spinal tissues. Manipulation alone cannot restore body postures or improve an altered sagittal spinal curve. Therefore, postural chiropractic adjustments, active exercises and stretches, resting spinal blocking procedures, extension traction and ergonomic education are deemed necessary for maximal spinal rehabilitation. Chiropractic studies that demonstrate structural improvements are sorely lacking and needed. The use of passive treatment modalities as the sole means of chiropractic intervention for the management of patients suffering with neuromusculoskeletal dysfunction no longer has a place in modern chiropractic practice after the acute phase of healing has passed.

Biomechanical Phenomena↗
PubMed1998

Three-dimensional spinal coupling mechanics: Part I. A review of the literature.

OBJECTIVE: To determine the state of knowledge relative to three-dimensional spinal coupled motion and to check the validity of currently accepted two-dimensional coupling as taught in chiropractic. DATA COLLECTION: A hand search of available reference texts and a computer search of literature from Index Medicus were collected with an emphasis on three-dimensional studies of human spinal movements. RESULTS: Most postural movements result in complicated three-dimensional spinal coupling in six degrees of freedom. Previous spinal coupling results based upon two-dimensional radiographic studies are inadequate and inaccurate. It is important that chiropractic colleges and techniques use the three-dimensional spinal kinematics to update their curricula and advance chiropractic treatment procedures. CONCLUSION: Full three-dimensional investigations of spinal coupling patterns have shown that the vertebrae rotate and translate in all three axes and that previous theories of spinal coupling based upon two-dimensional studies are inaccurate and invalid. Postural rotations and translations, which are the main motions studied in spinal coupling research, and altered configurations of the normal sagittal plane curves are the cause of both normal and abnormal spinal coupling patterns in three dimensions. Chiropractic letter listings (such as PRS, ASRP, etc.) are outdated, incomplete, invalid representations of coupled segmental movements. Mechanical loading of the neuromusculoskeletal tissues plays a vital role in position, dynamics, proper growth, repair and symptoms. Future studies of spinal kinematics should study the postural translations of the skull and thorax for their associated coupling in three dimensions. Combined postural rotations and translations along with altered sagittal curvatures need to be studied for their associated coupling characteristics as well.

Biomechanical Phenomena↗
PubMed1998

Reliability of spinal displacement analysis of plain X-rays: a review of commonly accepted facts and fallacies with implications for chiropractic education and technique.

BACKGROUND: Current medical, biomechanical, and chiropractic literature indicates that X-ray line drawing analysis for spinal displacement is reliable, with high Interclass Correlation Coefficients (ICCs) found in most studies. Normal sagittal spinal curvatures are being accepted as important clinical outcomes of care; however, just the opposite is taught in many chiropractic college radiology courses. OBJECTIVE: To review the current literature on X-ray line drawing reliability and abnormal static lateral positions. DATA SOURCES: Searches were performed on Medline, Chiro-LARS, MANTIS, and CINAHL on X-ray reliability, normal spinal position, and sagittal spinal curvatures as clinical outcomes. RESULTS: X-ray line drawing analysis for spinal displacement was found to have high reliability with a majority of ICCs in the .8-.9 range. The reliability for determining X-ray pathology was found to be only fair to good by both medical doctors and chiropractors and by both chiropractic and medical radiologists, with a majority of ICCs in the range .40-.75. Muscle spasms, facet hyperplasia, short pedicles and patient positioning errors have not been shown to alter sagittal plane alignment. The sagittal spinal curves are desirable clinical outcomes of care in surgery, physical therapy, rehabilitation and chiropractic. These results contradict common claims found in the indexed literature. CONCLUSION: X-ray line drawing is reliable. Normal values for the sagittal spinal curvatures exist in the literature. The normal sagittal spinal curvatures are important clinical outcomes of care. Patient positioning and postural radiographs are highly reproducible. When these standardized procedures are used, the pre-to-post alignment changes are a result of treatment procedures applied. Chiropractic radiology education and publications should reflect the recent literature, provide more support for X-ray line drawing analyses and applications of line drawing analyses for measuring spinal displacement on plain radiographs.

Anthropometry↗
PubMed1998

Further analysis of the reliability of the posterior tangent lateral lumbar radiographic mensuration procedure: concurrent validity of computer-aided X-ray digitization.

OBJECTIVE: To investigate the reliability of a specific method of radiographic analysis of the geometric configuration of the lumbopelvic spine in the sagittal plane, and to investigate the concurrent validity of a computer-aided digitization procedure designed to replace the more tedious and time-consuming manual measurement process. DESIGN: A blind, repeated-measures design was used. The results of radiographic measures derived through the traditional manual marking method were compared with measures derived by computer-aided digitization of lateral lumbopelvic radiographs. SETTING: Private chiropractic clinic. MAIN OUTCOME MEASURES: Pearson's product-moment correlation coefficients, paired sample t tests and intraclass correlation co-efficients (ICC) were used to examine intraexaminer reliability, and repeated measures of analysis of variance were used to examine interexaminer reliability for relative rotation angles for T12-L1, L1-L2, L2-L3, L3-L4, L4-L5, L5-S1, overall lordosis measurement [absolute rotation angle (ARA)] from L1-L5 and Cobb angle of overall lordosis measured from the inferior surface of T12 to the superior surface of S1, Ferguson's sacral base angle to horizontal, angle of pelvic tilt (arcuate angle) to horizontal and anteroposterior thoracic translation (Sz) in millimeters. RESULTS: ICC estimates for intraexaminer reliability were in the range of 0.96-0.98 for the L1-L5 ARA, a range of 0.87-0.99 for the arcuate angle measurement, 0.83-0.94 for the Ferguson's angle measurement, 0.88-0.95 for the Cobb angle measurement from the inferior surface of T12 compared with the superior surface of S1 and 0.98-1.00 for the translation measurement of the lower thoracic spine to S1 (Sz). The intersegmental measurement's (T12-L1, L1-L2, L2-L3, L3-L4, L4-L5, L5-S1) correlations ranged from a low of 0.55 to a high of 0.97. Examination of these findings suggests that the reliability for the three doctors is acceptable with only the T12-L1 intersegmental measure falling below 0.70 for the least experienced examiner. Average ICC of interexaminer reliability for manual and computer-aided digitizing examiners were the following: 0.96 for the L1-L5 ARA; 0.84 for the arcuate angle measurement; 0.82 for the Ferguson's angle measurement; 0.88 for the Cobb angle measurement; 1.00 for the Sz translation measurement; and values of 0.65, 0.73, 0.74, 0.75, 0.89 and 0.81 for relative rotation angle measurements T12-L1, L1-L2, L2-L3, L3-L4, L4-L5 and L5-S1, respectively. CONCLUSION: The data tend to support the reliability of this method of radiographic analysis of the geometric configuration of the lumbopelvic spine as viewed on lateral lumbopelvic radiographs. The additional data presented here tend to support the concurrent validity of the computer-aided digitization method of analysis inasmuch as the measures determined by the digitizing examiners are essentially identical to those determined by the manual method plus or minus the average standard error of measure of each value.

Humans↗
PubMed1998

Elliptical modeling of the sagittal lumbar lordosis and segmental rotation angles as a method to discriminate between normal and low back pain subjects.

Clinical significance of lumbar lordosis has not been agreed on. Our purpose is to compare lordotic measurements of normal and pain subjects and to test the validity of a new anthropometric model of lumbar curvatures. Digitized radiographic points (body corners) from standing lateral lumbar radiographs were modeled with ellipses in a least-squares method and were used to create segmental angles, a global angle at L1-L5, a Cobb angle from T12 to S1, Ferguson's sacral base angle, and an angle of pelvic tilt. Fifty normal subjects were matched in age, sex, weight, and height with 50 acute pain subjects, 50 chronic pain subjects, and 24 pain subjects with radiographic abnormalities. Of 11 angles, 2 distances, and 2 ratios, statistical analysis was significantly different across groups for 12 of these measurements, with the alternative hypotheses accepted for the other 3 measurements. The lordosis of both normal and low back pain subjects can be successfully modeled with a portion (approximately 86 degrees) of an ellipse, but with different major and minor axis ratios. The normal group's average elliptic lordosis has the smallest least-squares error, approximately 1 mm per digitized point, with (minor axis)/(major axis) ratio = 0.39, L1-L5 global angle = 40 degrees, and Cobb angle = 65 degrees. The chronic and radiographic abnormalities pain groups have an elongated ellipse with hypolordosis, reduced L1-L5 global angle = 29.6-35 degrees, reduced Cobb angle = 57-58 degrees, and elliptic axis ratio = 0.27-0.30. The acute pain group is hyperlordotic with the largest L1-L5 global angle, largest Cobb angle = 70 degrees, largest Ferguson's angle, and largest pelvic tilt angle.

Acute Disease↗
PubMed1997

Evaluation of the assumptions used to derive an ideal normal cervical spine model.

OBJECTIVES: To evaluate the accuracy of anatomical assumptions made to derive a geometrical, ideal, normal model of the upright, static, sagittal cervical spine, to make comparisons with other spinal models and to discuss the implications of a normal cervical model. BACKGROUND: Anatomical assumptions were made based on observations to assist in the development of a computerized geometrical model of the ideal upright, static, sagittal cervical spine. These assumptions address the magnitudes of the contribution made by the vertebral bodies and intervertebral discs to the overall magnitude and geometric shape of the cervical lordosis. STUDY DESIGN: (a) Data were collected from 400 lordotic lateral cervical radiographs and compared with the predictions of a geometric normal cervical lordotic model. Angels of intersecting tangent lines, drawn at posterior vertebral body margins, were measured at each disc space and between C2 and C7. Height-to-length ratios and an anterior weight-bearing distance were measured. (b) LITERATURE REVIEWs were obtained through Medline and Chirolars. RESULTS: (a) Modeling: the 400 sample subjects varied from the geometric model by approximately 5%. Subgroup averages, from partitioning the C2-C7 angle into 5 degrees intervals, were less than 8% in error to model predictions. (b) LITERATURE REVIEW: lordosis is the normal configuration for the cervical spine and many chiropractic empirical models are similar. CONCLUSIONS: The anatomical assumptions used to derive our normal geometric model of the cervical lordosis seem to be supported by the average values and literature reviewed. Two typical geometric configurations of the cervical spine were identified as a normal circular lordotic arc of 34 degrees and an ideal normal of 42 degrees. LITERATURE REVIEWed establishes cervical lordosis as a desirable clinical outcome of care.

Cervical Vertebrae↗
PubMed1997

Radiographic mensuration characteristics of the sagittal lumbar spine from a normal population with a method to synthesize prior studies of lordosis.

Standing lateral lumbar radiographs of 50 normal healthy subjects were retrospectively selected for evaluation of lumbar lordosis. The objective was to evaluate, in a normal population, global and segmental contributions to lordosis in the standing position, and to devise a method to compare the seemingly unrelated multitude of lordotic values in the literature. Because of a variety of positioning and measurement methods of lordosis in live subjects and cadavers, correlation of results is difficult. While often relying on simple pain questionnaires, studies of normal subjects rarely have complete medical history, physical, neurological, and orthopedic examinations. Standing lateral lumbar radiographs of 50 subjects, who had complete histories and normal examinations, were analyzed to determine overall lordosis, segmental contributions, and vertical sagittal alignment. Using posterior body tangents, the mean L1-L5 angle was -39.7 degrees, CobbT12-S1 = -65 degrees, Ferguson's sacral angle = 39 degrees, pelvic tilt angle was 49 degrees, and average RRAs (segmental angles) were RRAT12-L1 = -3.6 degrees, RRAL1-L2 = -4.1 degrees, RRAL2-L3 = -7.6 degrees, RRAL3-L4 = -11.7 degrees, RRAL4-L5 = -16.8 degrees, and RRAL5-S1 = -32.4 degrees. Using segmental rotation angles as a method to compare past and current literature, a normal standing lumbar lordosis of CobbT12-S1 = -61 degrees, range -55 degrees to -65 degrees, was determined with specific segmental angles.

Adolescent↗
PubMed1996

Comparisons of lordotic cervical spine curvatures to a theoretical ideal model of the static sagittal cervical spine.

STUDY DESIGN: Measurements from lateral cervical radiographs of randomly selected patients are compared with two proposed ideal models. OBJECTIVES: To evaluate lordotic cervical curvatures from a large population base, to provide a geometric sagittal cervical spine model, and to test the validity of the model to predict measured angles and distances. Averages of ranges and normal values for cervical lordosis under conditions of static equilibrium are sought. SUMMARY OF BACKGROUND DATA: Seven angles and three distances were taken from 400 randomly selected lateral cervical radiographs of patients at a private clinic. METHODS: The radiographic measurements are compared with predicted values from our geometric sagittal cervical spine model and the Delmas ideal cervical model. RESULTS: Values were predicted successfully by the geometric model with an average error of 5% compared with the radiographic measurements. The range of lordosis, measured at the posterior of C2 and C7, was 16.5-66 degrees, with a mean of 34 degrees. The average height-to-length ratio for the cervical spine was 0.97. CONCLUSIONS: Predicted values from the geometric model were comparable with the measurements of the relative rotation angles at each vertebral interspace, absolute rotation angles from C2 to C7, and height-to-length ratios. A cervical lordosis of 34 degrees and a height-to-length ratio of 0.97 are suggested for clinical and theoretical outcomes.

Adult↗
PubMed1996

Torque: an appraisal of misuse of terminology in chiropractic literature and technique.

OBJECTIVE: To assess the use of the term "torque" in the chiropractic literature and to analyze its usage in chiropractic technique procedures. DATA SOURCES, STUDY SELECTION AND DATA EXTRACTION: Articles were retrieved through literature searches of several indexing services [(MEDLINE, Index to Chiropractic Literature, Chiropractic Research Archives Collection (CRAC) and Chiropractic Literature Analysis and Retrieval System (ChiroLARS)] and hand searches in the technique section of a chiropractic college library. From textbooks, key terms included: Torque, Torsion, Biomechanics, Physics, Chiropractic, Nomenclature and Manipulation. For MEDLINE: Torque, Chiropractic Methods, Manipulation-Spinal Methods, Biomechanics, Nomenclature and Chiropractic Terminology. Texts and papers that discussed the word "torque" were reviewed for their association with the thrust of a spinal adjustment. Inferences of "torque" and its application were included to represent the present-day usage of the term in chiropractic. CONCLUSIONS: We believe that the term torque is misused in chiropractic literature. This misuse has been perpetuated in chiropractic college courses, student clinic examinations and state and national board examinations. We strongly suggest that references to the term torque that are not biomechanically correct must be removed from all such sources.

Chiropractic↗
PubMed1996

Chiropractic biophysics technique: a linear algebra approach to posture in chiropractic.

OBJECTIVE: This paper discusses linear algebra as applied to human posture in chiropractic, specifically chiropractic biophysics technique (CBP). MATHEMATICAL ANALYSIS: Rotations, reflections and translations are geometric functions studied in vector spaces in linear algebra. These mathematical functions are termed rigid body transformations and are applied to segmental spinal movement in the literature. Review of the literature indicates that these linear algebra concepts have been used to describe vertebral motion. However, these rigid body movers are presented here as applying to the global postural movements of the head, thoracic cage and pelvis. CONCLUSION: The unique inverse functions of rotations, reflections and translations provide a theoretical basis for making postural corrections in neutral static resting posture. Chiropractic biophysics technique (CBP) uses these concepts in examination procedures, manual spinal manipulation, instrument assisted spinal manipulation, postural exercises, extension traction and clinical outcome measures.

Biomechanical Phenomena↗
PubMed1995

Intra- and interexaminer reliability of the chiropractic biophysics lateral lumbar radiographic mensuration procedure.

OBJECTIVE: To determine the intra- and interexaminer reliability of a specific method of mensuration commonly used to evaluate the positional configuration of the lumbopelvic spine viewed on lateral lumbar radiographs. DESIGN: A blind, repeated-measures design was used. Lateral lumbopelvic radiographs were presented to each of three examiners in random order. Each film was marked and measurements were recorded. The films were cleaned of all markings and randomized again for a second run by each examiner. Each examiner's measurements were unavailable to the other examiners. SETTING: Private, primary-care chiropractic clinic. MAIN OUTCOME MEASURES: Anterior/posterior thoracic translation in millimeters, Ferguson's sacral-plane angle to horizontal, arcuate line angle to horizontal, L1 to L5 absolute rotation angle and four relative rotation angles for L1-L2, L2-L3, L3-L4 and L4-L5. Intra- and interrelibility of the three radiographic examiners were analyzed. RESULTS: Intraexaminer reliability for (a) L1-L5 absolute rotation angle was .98, with confidence intervals included in the range of 0.95-0.99, (b) anterior/posterior thorax translation [+/- Sz] was .97-.99, with confidence intervals included in the range of 0.94-1.00, (c) arcuate angle (AA) .40-.81, with confidence intervals included in the range of 0.07-0.90, (d) Ferguson's angle (FA) was .91-.97, with confidence intervals included in the range of 0.82-0.98, (e) relative rotation angle reliability ranges were L1-L2, .84-.94; L2-L3, .80-.85; L3-L4, .78-.89; L4-L5, .87-.92. Interexaminer reliabilities for the three examiners ranged from .66-.98. CONCLUSION: With the exception of the arcuate angle measurement, the reliabilities for all other measurements were at least .78. Those measurements with reliabilities approaching .80 or better would be considered accurate enough for use in future clinical studies. The arcuate angle measurement may have been least reliable because of the subjective nature of the method of affixing a best-fit line to a radiographic landmark that often takes on the appearance of a mild curvature. Establishing reliability is an important first step toward evaluating these and other similar radiographic measurements that have yet to be examined for their validity.

Analysis of Variance↗
PubMed1994

The efficacy of cervical extension-compression traction combined with diversified manipulation and drop table adjustments in the rehabilitation of cervical lordosis: a pilot study.

OBJECTIVE: To experimentally investigate the effect of cervical extension-compression traction combined with diversified chiropractic manipulation and drop table adjusting in establishing or increasing cervical lordosis. DESIGN: Blinded, before and after trial with pre- and postlateral cervical radiographic measurement. SETTING: Primary care private chiropractic clinic in Saugus, MA. SUBJECTS: A) Control group--convenience sample who had no health care for 10-14 wk, 30 persons. B) Treatment group 1, nonrandomized control trial, 35 persons, whose pre- and postlateral cervical radiographs were taken 10-14 wk apart and whose radiographs clearly depicted C1 through C7. C) Treatment group 2, nonrandomized control trial, 30 persons, whose pre- and postlateral cervical radiographs were taken 10-14 wk apart and whose radiographs clearly depicted C1 through C7. INTERVENTIONS: Treatment group 1: diversified spinal manipulation, drop table adjustments and cervical extension-compression traction five times per week for 10-14 wk (12 wk +/- 2). Treatment group 2: diversified spinal manipulation and drop table adjustments five times per week for 10-14 wk (12 wk +/- 2). MAIN OUTCOME MEASURES: Anterior head translation millimeters, C2 to C7 absolute rotation angle, angle of C1 to horizontal (atlas plane angle), five relative rotation angles (C2-3, C3-4, C4-5, C5-6, C6-7) and qualitative classification of lordotic configuration. RESULTS: No statistically significant changes existed between the pre- and posttests for the control group except in the C6-7 relative rotation angle. In the treatment group 1, statistically significant differences were found in all X-ray markings. Twenty-nine of 35 members have a lordosis after treatment compared to 11 of 35 before treatment. The C2 to C7 angle changed an average 13.2 degrees, C1 to horizontal changed an average 9.8 degrees, the anterior head translation reduced an average of 6.8 mm, the average relative rotation angle changed: C2-3: 3.1, C3-4: 5.5, C4-5: 4.80, C5-6: 2.7 and C6-7: 1.1. In the treatment group 2, no statistically significant changes existed between the pre- and posttests except atlas angulation to horizontal which increased an average of 3.0 degrees. CONCLUSIONS: A transformation to a lordotic configuration or increase in lordotic configuration occurred and was measured in the majority of treatment group 1 subjects, while no change in the control group and essentially no change in treatment group 2 was measured. Extension-compression traction combined with diversified chiropractic manipulation and drop table adjusting procedures may improve or partially reestablish the cervical lordosis in 10-14 wk of daily care.

Adult↗