Approximately 85%–95% of LBP cases have no identifiable cause or pathology and are, therefore, classified as non-specific LBP (NS-LBP). Low back pain (LBP) is one of the most common musculoskeletal disorders and a leading cause of disability, globally creating a substantial personal, community, and financial burden ( Airaksinen et al., 2006 Delitto et al., 2012 Itz et al., 2013 Maher et al., 2017). The present results on STAs, based on dual fluoroscopic measurements in healthy adult subjects, presented an anatomical direction, marker location, and anatomic segment dependency, which might help describe and quantify STAs for the lumbar spine kinematics and thus help develop location- and direction-specific weighting factors for use in global optimization algorithms aimed at minimizing the effects of STAs on the calculation of lumbar joint kinematics in the future. The STA at the spinous process was significantly lower than that on both sides in the AP direction ( p < 0.05). During extension, the lower lumbar (L4–L5: 2.7 ± 0.7 mm) exhibited significantly less STAs than that exhibited by the upper lumbar region (L1–元: 6.1 ± 3.3 mm) ( p < 0.05). During flexion, the STA at the lower lumbar region (L4–L5: 13.5 ± 6.5 mm) was significantly higher than that at the upper lumbar (L1–元: 4.0 ± 1.5 mm) in the PD direction ( p < 0.01). For all the participants, STAs continuously increased in the AP direction and exhibited a reciprocal trend in the PD direction. The flexion angles between the upper and lower lumbar segments and adjacent intervertebral segments (L2–L5) throughout the cycle were calculated. The STAs in the anterior/posterior (AP), medial/lateral (ML), and proximal/distal (PD) directions were investigated. Six healthy volunteers were imaged using a biplanar radiographic system, and thirteen skin markers were mounted on every volunteer’s lower back while performing weight-bearing forward–backward bending. This study aimed to 1) quantify the in vivo STAs of the human lower back in three-dimensional directions during weight-bearing forward–backward bending and 2) determine the effects of the STAs on the calculated flexion angles between the upper and lower lumbar spines and adjacent vertebrae by comparing the skin marker (SM)- and virtual bone marker (VM)-based measurements. Additionally, the patterns of the STA on the lumbar spine remain unclear. Traditional optical motion capture (OMC) with retroreflective markers is commonly used to measure joint kinematics but was also reported with unavoidable soft tissue artifacts (STAs) when quantifying the motion of the spine. 6TAOiMAGE Medical Technologies Corporation, Shanghai, China.
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