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Clin Orthop Surg. 2019 Dec;11(4):482-489. doi: 10.4055/cios.2019.11.4.482. Epub 2019 Nov 12.

Locating the Instant Center of Rotation in the Subaxial Cervical Spine with Biplanar Fluoroscopy during In Vivo Dynamic Flexion-Extension.

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Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea.
Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea.
Department of Bioengineering, Chung-Ang University College of Engineering, Seoul, Korea.



Recently, biplanar fluoroscopy is used to evaluate the cervical kinematics, especially to locate the instant center of rotation (ICR) during in vivo motion. This study aims to ascertain the ICR at each cervical segment in the sagittal plane during dynamic motion and assess the differences from previous studies.


While three healthy subjects were performing full flexion-extension, two oblique views aligned horizontally and angled at approximately 55° were obtained by biplanar fluoroscopy. The minimum degree to detect significant movement in a helical axis model was set at 2°, and anterior-posterior and superior-inferior locations of each ICR were defined. To evaluate the possible distribution area and overlapping area of the ICR with disc space, we drew a circle by using the calculated distance between each coordination and the mean coordination of ICR as the radius.


During flexion-extension motion, the mean superior-inferior location of the ICR became progressively more superior, except the C5-6 segment (p = 0.015), and the mean anterior-posterior location of the ICR became progressively more anterior without exception from C2-3 to C6-7 segments, but anterior-posterior ICR locations were not significantly different among segments. The overlapping area with the distribution circle of ICR was mainly located in the posterior half in the C3-4 segment, but the overlapping area was about 80% of the total disc space in C4-5 and C6-7 segments. The overlapping was more noticeable in the lower cervical segments after exclusion of the outlier data of the C5-6 segment in subject 1.


The ICR in the cervical spine showed a trend of moving progressively more superiorly and anteriorly and the disc space overlapping the distribution circle of ICR increased along the lower motion segments except the C5-6 segment. These findings could provide a good basis for level-specific cervical arthroplasty designs.


Biplanar fluoroscopy; Cervical spine; Fluoroscopy; Instant center of rotation; Kinematics; Rotation

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