ASNR 2015

Use of a Novel MRI-Compatible Head-Positioning Device for the Three Dimensional Kinematic Analysis of the Cervical

Spine in Axial Rotation

1. Student, Illinois Mathematics and Science Academy, Aurora, IL, USA

2. PhD Candidate, Interdepartmental Neuroscience Program, Northwestern University, Chicago, IL, USA

3. Professor and Director, Spine Biomechanics Laboratory, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

4. Assistant Director, Spine Biomechanics Laboratory, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

5. Professor, Department of Radiology, Northwestern University, Chicago, IL, USA

Poster #: EP-153

Authors and Affiliations

Jyotsna Bitra1, Jessica Phung1, Kenneth A. Weber II2, Nozomu Inoue3, Alejandro A. Espinoza Orías4, and Todd B. Parrish5

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The authors have no disclosures.

Disclosures

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Cervical Spine Anatomy

● Upper Cervical Spine○ Occiput = C0○ Atlas = C1○ Axis = C2○ Most of the axial rotation occurs

between C1 and C2● Lower Cervical Spine

○ C3-C7● Intervertebral Joints

○ Intervertebral discs between adjacent vertebrae

○ Fibrocartilaginous joint○ Shock absorbers

● Facet Jointso Synovial planar jointso Between adjacent superior and

inferior articulating processes

Austin et al., 2014

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Segmental Motion

Ishii, T., et al. (2004)

● 3D cervical spine segmental motions (6 degrees of freedom)○ +/- Rotations around X,Y, and Z axes○ +/- Translations along X, Y, and Z axes

● Characteristic coupled segmental motions of the cervical spine

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Previous Studies

● Ishii T et al. 2004○ Imaged healthy patients in 15 degree intervals of axial head rotation○ 1.0 T MRI Scanner○ Calculated 3D segmental motions using a voxel-based registration

technique● Upper Cervical Spine

○ Coupled lateral bending with axial rotation in the direction opposite of axial rotation at C0-C1 and C1-C2

○ Coupled extension with axial rotation at C0-C1 and C1-C2● Subaxial Cervical Spine

○ Coupled lateral bending with axial rotation in the same direction of axial rotation at all levels

○ Coupled extension with axial rotation occurred at C2-C3, C3-C4, and C4-C5

○ Coupled flexion with axial rotation at C5-C6, C6-C7, and C7-T1● No head-positioning device was used to control position of the head

relative to the thorax

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Purpose

1. MRI allows a non-invasive method of analyzing cervical spine segmental motion

2. Previous studies failed to utilize a head-positioning device to control the amount of angular displacement of the head relative to thorax

3. Design and test an MRI-compatible head-positioning device to image the cervical spine with controlled axial rotation of head

Windsor, R.E, (2014).

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Head-Positioning Device● MRI-compatible device made from ABS (acrylonitrile

butadiene styrene) plastic and football helmet (Riddell, Rosemont, IL, USA)

● Wheel and axle design● Allows for 180 degrees head rotation

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Imaging

● Siemens TIM Trio 3.0 T Scanner

● Two 4-channel flex coils were placed anterior and posterior to the head and neck while scanning

● Imaged using navigated multi-echo (4) 3D MPRAGE acquisition with IPAT

○ TE 2 ms, TR 2540 ms, flip angle 7°,○ 1 average, 1 mm x 1 mm x 2 mm voxels○ Acquisition time 5.5 minutes per image

● 4 males, 2 females (mean age 33.5+- 8.2 years) with no complaints of neck pain

● Subjects were scanned in three different positions of axial head rotation○ Neutral, 40 degrees of right head rotation,

and 40 degrees of left head rotation

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MRI Images Using the Head Positioning Device

40° Right Rotation 40° Left RotationNeutral

Mimics 16.0, Materialise NV, Leuven, Belgium

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Manual Segmentation of Cervical Vertebrae

40° Right Rotation 40° Left RotationNeutral

Mimics 16.0, Materialise NV, Leuven, Belgium

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Render 3D Models from Vertebral Masks

40° Right Rotation 40° Left RotationNeutral

Mimics 16.0, Materialise NV, Leuven, Belgium

R L

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Calculation of 3D Segmental Motions using the Volume Merge Method

Render 3D Models Point Cloud Format Transformation of neutral vertebra to transformed

vertebra

Ochia, R.S. et al., (2006)

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Coupled Segmental Motion

● Expected approximately 40° of axial rotation throughout the cervical spine

● Average axial rotation summed across all segments ● 34.8° ± 13.8° left rotation

during left head rotation● 41.3° ± 6.5° right rotation

during right head rotation● Translations along each axis

can also be calculated

LR= Left Head Rotation, RR = Right Head RotationRx = + Flexion, - ExtensionRy = + Right Lateral Flexion, - Left Lateral FlexionRz = + Left Axial Rotation, - Right Axial Rotation

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Conclusions

● The device allowed for the precise control of axial head rotation while in the MRI scanner

● All subjects were able to tolerate the device and head positioning throughout the scans

● Image quality was adequate to manually segment the data

● Our results were similar to previously published studies● In the future, the feasibility of using this device in a neck

pain population will be assessed

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References

● Austin N, Krishnamoorthy V, Dagal A. Airway management in cervical spine injury. International Journal of Critical Illness and Injury Science. 2014;4(1):50-56.

● Ishii T, Mukai Y, Hosono N, Sakaura H, Nakajima Y, Sato Y, Sugamoto K, Yoshikawa H. Kinematics of the upper cervical spine in rotation: in vivo three-dimensional analysis. Spine. 2004 Apr 1;29(7):E139-44.

● Ishii T, Mukai Y, Hosono N, Sakaura H, Fujii R, Nakajima Y, Tamura S, Sugamoto K, Yoshikawa H. Kinematics of the subaxial cervical spine in rotation in vivo three-dimensional analysis. Spine. 2004 Dec 15;29(24):2826-31.

● Ochia RS, Inoue N, Renner SM, Lorenz EP, Lim TH, Andersson GB, An HS. Three-dimensional in vivo measurement of lumbar spine segmental motion. Spine (Phila Pa 1976). 2006 Aug 15;31(18):2073-8.

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Acknowledgments

Authors and Collaborators:

Parrish Neuroimaging Laboratory

Department of Radiology

Northwestern University

Center for Translational Imaging

•Todd B. Parrish, PhD

•Kenneth A. Weber II, DC

•Jennie Chen, PhD

•Xue Wang, PhD

•Brian Williams, BSN, RN

Rush University Medical Center

Spine Biomechanics Laboratory

•Nozomu Inoue, MD, PhD

•Alejandro A. Espinoza Orías, PhD

Funding Support

•NCMIC Foundation, Inc.

•NCCIH F32AT007800

•NICHD T32HD057845