Instantaneous Axes of Rotation of the Lumbar Intervertebral Joints

Lateral radiographs of ten normal individuals were studied to determine the location of the instantaneous axis of rotation (IAR) of every lumbar vertebra for the movements, of flexion and extension from the upright position and flexion from the fully extended position; and errors involved in the technique were quantified to establish confidence limits for the results of the calculations. The distribution of the IARs was found to fall within a small range from the mean location at each level, particularly for the movement of flexion from the extended position. Within-observer and between-observer errors occurred in tracing and superimposing radiographs and marking x and y coordinates. Unacceptably large errors occur when the movement of the joint is less than 5°, and only the IAR for flexion from extension can be plotted with acceptable confidence. This result invalidates the notion that plotting centrodes may be of diagnostic value in recognizing mechanical disorders. The determination of a single extension to flexion IAR may be of more value clinically, to which end this study provides essential normative data.