Intervertebral range of motion characteristics of normal cervical spinal segments (C0-T1) during in vivo neck motions

The in vivo intervertebral range of motion (ROM) is an important predictor for spinal disorders. While the subaxial cervical spine has been extensively studied, the motion characteristics of the occipito-atlantal (C0-1) and atlanto-axial (C1-2) cervical segments were less reported due to technical difficulties in accurate imaging of these two segments. In this study, we investigated the intervertebral ROMs of the entire cervical spine (C0-T1) during in vivo functional neck motions of asymptomatic human subjects, including maximal flexion-extension, left-right lateral bending, and left-right axial torsion, using previously validated dual fluoroscopic imaging and model registration techniques. During all neck motions, C0-1, similar to C7-T1, was substantially less mobile than other segments and always contributed less than 10% of the cervical rotations. During the axial rotation of the neck, C1-2 contributed 73.2 ± 17.3% of the cervical rotation, but each of other segments contributed less than 10% of the cervical rotation. During both lateral bending and axial torsion neck motions, regardless of primary or coupled motions, the axial torsion ROM of C1-2 was significantly greater than its lateral bending ROM (p < 0.001), whereas the opposite differences were consistently observed at subaxial segments. This study reveals that there are distinct motion patterns at upper and lower cervical segments during in vivo neck motions. The reported data could be useful for the development of new diagnosis methods of cervical pathologies and new surgical techniques that aim to restore normal cervical segmental motion.