Automated Analysis of Lumbar Spine Kinematics from Dynamic Videofluoroscopy

描述（由申请人提供）：脊柱推拿疗法（SMT）是一种经常用于治疗腰痛（LBP）的补充疗法。目前的理论认为，SMT纠正异常腰椎节段间运动，但在体内节段间运动的检测和表征还没有很好地建立。因此，SMT对节段间运动的影响尚不清楚。我们广泛的长期目标是研究SMT对腰椎节段间运动的影响，并确定SMT的临床效果与节段间运动变化之间的关系。为了实现这一点，有必要开发一种有效的，准确的和可靠的方法来测量在体内节段间的运动。视频荧光透视有望提供低辐射暴露的连续运动数据，但数据处理方法尚未达到能够有效临床使用的复杂程度;它们仍然需要手动识别标志和明确的椎体分割。我们假设，2-D腰椎节段间运动学可以有效和准确地量化视频透视图像。我们建议通过解决以下具体目标来测试这一假设：1）开发一种自动化软件应用程序，以量化动态视频荧光透视图像中腰椎的2-D节段间运动学。该应用程序基于Analyze生物医学成像编程环境中的现有模块，将量化节段间旋转和旋转中心平移以及整体（L2-L5）腰椎运动。 2)进行动态体外脊柱测试，以确定使用自动化软件应用程序评估2-D节段间运动学的准确性和局限性（目标1）。体外腰椎运动的X线透视图像将与已知精度的光电跟踪系统的运动学参数同时获得。来自自动化软件的运动学数据将与光电跟踪系统数据进行比较。3)使用自动化软件应用程序，评估在无症状受试者和慢性LBP受试者中通过主动腰椎屈曲、伸展和侧弯的视频透视图像测量体内腰椎节段间运动参数的可靠性（目标1）。将在两个时间点获得10例无症状受试者和10例慢性LBP受试者的视频荧光镜图像。将确定软件应用程序中运动学参数的可靠性。将计算参数平均值和变异（受试者间和受试者内）。可能导致新的假设SMT对节段间运动的影响的趋势将被检查。本项目中开发和测试的新型软件应用程序将使研究能够直接测试SMT治疗腰痛的主要生物力学原理。它还将使我们能够进行临床研究，在位置，类型和剂量方面改进SMT的应用。

DESCRIPTION (provided by applicant): Spinal manipulative therapy (SMT) is a complementary therapy frequently used to treat low back pain (LBP). Current theories propose that SMT corrects abnormal lumbar intersegmental motion, but the detection and characterization of in vivo intersegmental motion are not well established. Thus, the effect of SMT on intersegmental motion is unknown. Our broad, long term objective is to investigate the effect of SMT on lumbar intersegmental motion and to determine the relationship between the clinical effects of SMT and intersegmental motion changes. To accomplish this, it is necessary to develop an efficient, accurate and reliable method of measuring in vivo intersegmental motion. Videofluoroscopy holds promise of providing continuous motion data with low radiation exposure but data processing methods have not reached a level of sophistication that enables efficient clinical use; they still require manual identification of landmarks and explicit vertebral segmentation. We hypothesize that 2-D intersegmental kinematics of the lumbar spine can be efficiently and accurately quantified from videofluoroscopic images. We propose to test this hypothesis by addressing the following Specific Aims: 1) Develop an automated software application to quantify 2-D intersegmental kinematics in the lumbar spine from dynamic videofluoroscopic images. This application, based on existing modules within the Analyze biomedical imaging programming environment, will quantify intersegmental rotation and translation of the center of rotation, and global (L2-L5) lumbar motion. 2) Conduct dynamic in vitro spine testing to establish the accuracy and limitations of assessing 2-D intersegmental kinematics using an automated software application (Aim 1). Fluoroscopic images of in vitro lumbar motion will be obtained simultaneously with kinematic parameters from an optoelectric tracking system of known accuracy. Kinematic data from the automated software will be compared to the optoelectric tracking system data. 3) Assess the reliability of measuring in vivo lumbar intersegmental motion parameters from videofluoroscopic images of active lumbar flexion, extension, and lateral bending in asymptomatic subjects and subjects with chronic LBP using an automated software application (Aim 1). Videofluoroscopic images of 10 asymptomatic subjects and 10 subjects with chronic LBP will be obtained at two time points. Reliability of kinematic parameters from the software application will be determined. Parameter means and variation (among and within subjects) will be calculated. Trends that might lead to new hypotheses of the effects of SMT on intersegmental motion will be examined. The novel software application developed and tested in this project will enable studies that directly test the primary biomechanical rationale for treating low back pain with SMT. It will also enable us to conduct clinical studies that refine the application of SMT in terms of location, type and dose.