Assessment of the Mobility Function of the Cervical and Lumbar Spine

Assessment of the Mobility Function
of the Cervical and Lumbar Spine
© zebris Medical GmbH Release 05/2005
zebris Medical GmbH
Max-Eyth-Weg 42
88316 Isny im Allgäu
Germany
Tel.: +49 7562 / 9726-0
Fax: +49 7562 / 9726-50
E-mail: zebris@zebris.de
Internet: www.zebris.de

Features
• All measurement data can be observed
directly on the monitor in realtime.
• Comparison of several measurements
through multiple display.
• Printout via color printer at low operating
costs.
• The measured data can be exportet to
ASCII data files and further processed.
• Form for entry of patient data, findings,
etc.
• Easy menu-driven operation.
• Automatic display of standard and limit
values.
• Program operates under Windows 98,
2000 and XP.
Introduction
The examination of the head movement
has become routine during the clinical
examination of patients with problems in the
area of the cervical spine.
In addition to checking the course of treatment,
when carrying out reviews in practice,
for example after traffic accidents or to
assess the ability to work, an objective,
precise and reproducible deter-mination of
the cervical and lumbar spine function is
required.
The measuring systems, together with the
special application aids, permits the precise
and fast determination of mobility and
coordinated movements of all degrees of
freedom of spinal column sections.
The movement can be carried out both in
an active as well as in a passive manner.
Measuring principle
The position of three ultrasound transmitters
on a measuring and reference
mount is continuously determined by
means of the process for measuring the
transmission time of the sound pulses.
From this, all the angular and translation
movements can be computed.
Apart from the extent of movement, in
particular deviating movements and the
quality of movement can be precisely
determined.
WinSpine Triple © zebris Medical GmbH

The WinSpine software
The "WinSpine" software for spine analysis
can run under up to date Windows
operating systems.
The WinSpine database system has three
levels for organising the measured data:
The highest level is the project level. Here
you can memorise various projects, patient
groups or program users.
In the next level, the patient names are
input. In the final level, the measured data
files are listed.
The program contains a standard data-base
with which the bar charts in the report can
be superimposed with age and gender
specific standard data.
In the screen page for preparing the
measurement, different types of
examinations can be selected.
In addition, adjustments are made here to
the measuring system, such as the angle of
inclination of the measuring sensor, the
measuring rate, the distance or the scaling
of the measuring curves during the real
time measurement. These settings are
memorised for every measuring arrangement.
For measuring the cervical or lumbar spine
function the "Triple Cervical" or "Triple
Lumbar" examination must be set.
© zebris Medical GmbH WinSpine Triple

Preparation of the patient
The cervical spine is examined with the
Triple Cervical marker set.
To examine the cervical spine, a special
head mount is used with integrated triple
markers.
This permits a quick and reproducible
fastening on the head. In addition, a triple
reference marker is required for fastening
on the shoulder.
Examination of the lumbar spine with the
Triple Lumbar marker set.
The triple reference markers are placed on
the sacrum and are fastened to the body
with the elastic Velcro strip. The marker
mount points downwards.
The triple measuring marker is placed in
way of the lower thoracic spine and is also
fixed in place with a Velcro strip.
By means of the special mounts, an
optimum transmission of the ultrasound
pulses to the measuring sensor is ensured
during all movements.
WinSpine Triple © zebris Medical GmbH

Carrying out the measurement
Examination of the cervical spine:
A calibration in the neutral position is
initially carried out.
The patient then makes head movements
up to the maximum forward and backward
inclination.
As far as possible, the movements are
carried out uniformly and repeatedly.
The next measurement consists of the axial
rotation of the head.
In a further procedure, sideways movements
are carried out.
Selecting the time sections in the "Signal Viewer"
Upon completion of the measurement, by
setting the markings interactively, the
time sections for analysis in the report are
selected. The report is then produced
automatically.
Upon completion of this measurement, the
rotational movements in maximum forward
and backward inclination of the head are
carried out.
The examination of the lumbar spine is
carried out in the same manner as the
cervical spine.
However, in this cases, only the movements
for forward and backward inclination,
rotation and sideways movement are
examined.
In the signal viewer, individual curves can
also be enlarged and superimposed or
individual measured data can be obtained.
Data export
The measured data can be exported and
further processed as ASCII data files.
© zebris Medical GmbH WinSpine Triple

Cervical Spine Report
In the report, the measured values of the
maximum motional extent are shown together
with standard ranges as bar charts.
The measured values are calculated from
the maximum or mean values of the curve
sections chosen in the signal viewer. The
changeable standard ranges are marked as
light colour sections and are memorised in
a database in an age and gender dependent
manner.
The display of the mobility on its own
cannot provide adequate information on the
mobility pattern.
For example, an apparently adequate
mobility can be achieved through erasive
movements. In addition, the observation of
the actual motion sequence provides
valuable information for evaluating the
function.
To display the movement curve and alternative,
respectively linked movements,
phase charts are shown in the report. In this
regard, the angle velocity is entered against
the movement angle. Every executed main
movement produces its own phase diagram.
From the curve shape, the movement
characteristics can be derived and allocated
to the pertinent movement phases. Where a
movement is harmonious, the curves are
almost circular in shape.
In the following example "Rotation in max.
Anteflexion" a disturbance in the rotation of
the head to the left is indicated.
The mobility is limited (1), whereby a
stronger alternative movement was carried
out at the same time (2). The analysis
shows a disturbance in the upper cervical
vertebrae joints.
When analysing the lumbar spine movement,
the synkinesis of the spine to the
rotation of the pelvis can also be dis-played.
Additional analyses on the coordination of
the pelvic and spinal column movement are
being prepared.
WinSpine Triple © zebris Medical GmbH

Example: Functional restrictions, one year after whiplash injury
© zebris Medical GmbH WinSpine Triple

Technical Data
Maximum measuring rate:
Typical measuring rate:
Measuring accuracy:
Examination time:
Datenexport:
Other available programs:
WinSpine Single:
WinSpine Pointer:
WinGait:
WinArm / 3DA:
WinBalance:
WinData:
max. 200Hz / Anzahl der US-Marker
25 Hz / per US marker
± 0.5 degrees
5 - 10 minutes
Rohkoordinaten als ASCII - Files
Examination of mobility and coordination
with single markers
Examination of posture, shape and mobility
with the pointer
Gait analysis
Motion analysis in movement disorders
Equilibrium analysis
Data acquisition program
WinSpine Triple © zebris Medical GmbH