1. Alex Breen, Fiona Mellor, Alan Breen Institute for Musculoskeletal Research and Clinical Implementation Anglo-European College of Chiropractic/Bournemouth University e: alexbreen@aecc.ac.uk A PRELIMINARY COMPARISON OF RECUMBENT AND WEIGHT BEARING MOTION PATTERNS IN ADULT MALES

2. Automated image tracking and kinematic data extraction

3. Examples of image sequence acquisition Passive recumbent right side-bendingActive weight bearing flexion From.. Breen A.C., Teyhen DS, Mellor FE, Breen AC, Wong KWN, Deitz A. Measurement of Inter Vertebral Motion Using Quantitative Fluoroscopy: Report of an International Forum and Proposal for Use in the Assessment of Degenerative Disc Disease in the Lumbar Spine. Advances in Orthopaedics. 2012;2012(802350).

4. Study purpose To explore the differences between recumbent and weight bearing lumbar inter vertebral motion from L2-S1 in flexion - extension and side bending in the same participants in terms of: Inter-vertebral range of motion (IV-ROM rotation) Individual level contribution to L2-S1 motion Initial attainment rate

5. Methods ____ ____ ____ _____ ____ ____ __ _________ ____ ____ ___ __ ___ ________ ____ _________ ____ _________ ________ _______ ___ _______ ____________ __ ______ ___ __________ ____ __ ____ ______ ___ ___ __________ Image data from 10 males aged 30-66 with no disabling back pain the in the previous year extracted from reference database. Analysed for angular IV-ROM, contribution to L2-S1 motion and attainment rate in both planes and all 4 directions

6. Dvorak J, Panjabi, M.M., Chang, D.G., Theiler, R., Grob, D. Functional radiographic diagnosis of the lumbar spine: flexion- extension and lateral bending. Spine. 1991;16(5):562-71. Results – IV-ROM

7. Results – Contribution to L2-S1 motion Flexion-extension

8. Results – Contribution to L2-S1 motion Side bending

9. Results – Attainment Rate Mellor F, Muggleton, J.M., Bagust, J., Mason, W., Thomas, P.W., Breen, A.C. Mid-lumbar lateral flexion stability measured in healthy volunteers by in-vivo fluoroscopy. Spine. 2009;34(22):E811-E7.

10. Attainment Rate – Flexion-Extension

11. Attainment Rate – Side bending

12. Summary Lumbar IV-ROMs in healthy controls measured by QF are similar to previous studies. In flexion-extension, L5-S1 contributed more than any other level for both configurations. Moreover, weight bearing contributed more in flexion in the upper lumbar spine. These findings were also reflected in attainment rates. In side-bending, the weight bearing configuration gave higher IV-ROMS, which were reflected in the mid-lumbar spine. However, attainment rates were greater in recumbent motion.

13. Conclusion Inter-vertebral motion patterns in pain-free controls under controlled trunk motion, appear to be quantifiably different in recumbent and weight bearing postures and in the coronal and sagittal planes. If analysis of the larger database bears these differences out, it will enable investigators to make informed choices about optimal acquisition protocols for the research and clinical uses of QF.

14. Thank you for listening. Questions and Comments? Alexander Breen E: alexbreen@aecc.ac.uk Acknowledgements: Anglo-European College of Chiropractic Ortho Kinematics The team at IMRCI

15. Inclusion/exclusion criteria Reference study Age20 to 70 SexMale or female BMILess than 30 Must be able to understand written information√ Must be willing to participate and able to freely give informed consent√ Evidence of non pregnancy√ Consent to GP being informed√ Have no history of low back pain that prevented activity for at least 1 day in the previous year (Mason 1994) √ No previous intervention (i.e. Spine, abdominal or pelvic surgery, treatment for osteoporosis ) √ Any Medical radiation exposure in the last year√ Any radiation exposure in the last 2 years greater than 8mSv√ Current involvement in any other research study.√ This Study: Age; 30-66 Sex; Male

16. Image acquisition

17. Image QA and enhancement

18. Calculations of inter-vertebral angles (IVAs)