Study Design, Dynamic lumbar flexion-extension motion was assessed by
videofluoroscopy. Objectives. To identify the motion patterns of the w
hole lumbar spine in normal subjects and in patients with low back pai
n or spondylolisthesis during actual movement. Summary of Background D
ata. Assessment of lumbar instability on terminal radiographs is contr
oversial. Information regarding spinal kinematics during actual moveme
nt In vivo Is scarce. Methods. Fluoroscopic lumbar sagittal motion vid
eos were recorded in volunteers (n = 13; mean age, 22.3) and in patien
ts with chronic low hack pain (n = 8; mean age, 43.5) and degenerative
spondylolisthesis (n = 8; mean age, 63.1) while the subjects bent for
ward from a standing neutral position (eccentric motion) and then retu
rned to the original position (concentric motion). The videos recorded
approximately 8 seconds of motion and were converted to still images
at 5 frames per second. Disc angles from the horizontal line were meas
ured to estimate sagittal rotation of each segment, Disc degeneration
was evaluated on T2-weighted mid-sagittal magnetic resonance image. Re
sults. In the volunteer group, six exhibited sequentially spreading mo
tion, four exhibited simultaneous motion, and three showed an altered
motion-spreading pattern in the eccentric phase. The first two pattern
s were considered normal. Six (67%) of the patients with chronic low b
ack pain also showed normal patterns; but seven (88%) of the patients
with degenerative spondylolisthesis showed disordered patterns. The or
der of motion in the concentric phase was also different among the thr
ee groups. Prolonged deflection of the slipped segment was observed mo
re frequently in the patients with degenerative spondylolisthesis, Dis
c degeneration was not always associated with motion-spreading order a
nd the motion patterns. Conclusion. Segmental instability influences t
he whole lumbar motion in patients with degenerative spondylolisthesis
. The patients with chronic low back pain did not show a significant d
ifference when compared with the volunteers.