• Fabio Galbusera, Frank Niemeyer, Youping Tao, Andrea Cina, Luca Maria Sconfienza, Annette Kienle, and Hans-Joachim Wilke.
• Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, viale Galeazzi 4, 20161, Milan, Italy. fabio.galbusera@grupposandonato.it.
• Eur Spine J. 2021 May 1; 30 (5): 1108-1116.

PurposeWe investigated the flexion-extension range of motion and centre of rotation of lumbar motion segments in a large population of 602 patients (3612 levels), and the associations between lumbar motion and other parameters such as sex, age and intervertebral disc degeneration.MethodsLumbar radiographs in flexion-extension of 602 patients suffering from low back pain and/or suspect instability were collected; magnetic resonance images were retrieved and used to score the degree of disc degeneration for a subgroup of 354 patients. Range of motion and centre of rotation were calculated for all lumbosacral levels with in-house software allowing for high degree of automation. Associations between motion parameters and age, sex, spinal level and disc degeneration were then assessed.ResultsThe median range of motion was 6.6° (range 0.1-28.9°). Associations between range of motion and age as well as spinal level, but not sex, were found. Disc degeneration determined a consistent reduction in the range of motion. The centre of rotation was most commonly located at the centre of the lower endplate or slightly lower. With progressive degeneration, centres of rotation were increasingly dispersed with no preferential directions.ConclusionThis study constitutes the largest analysis of the in vivo lumbar motion currently available and covers a wide range of clinical scenarios in terms of age and degeneration. Findings confirmed that ageing determines a reduction in the mobility independently of degeneration and that in degenerative levels, centres of rotation are dispersed around the centre of the intervertebral space.

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