{"id":"https://openalex.org/W2072880740","doi":"https://doi.org/10.1097/00007632-199412000-00008","title":"On the Understanding of Clinical Instability","display_name":"On the Understanding of Clinical Instability","publication_year":1994,"publication_date":"1994-12-01","ids":{"openalex":"https://openalex.org/W2072880740","doi":"https://doi.org/10.1097/00007632-199412000-00008","mag":"2072880740","pmid":"https://pubmed.ncbi.nlm.nih.gov/7899958"},"language":"en","primary_location":{"id":"doi:10.1097/00007632-199412000-00008","doi":"https://doi.org/10.1097/00007632-199412000-00008","is_oa":false,"landing_page_url":"https://doi.org/10.1097/00007632-199412000-00008","pdf_url":null,"source":{"id":"https://openalex.org/S4026894","display_name":"Spine","issn_l":"0362-2436","issn":["0362-2436","1528-1159"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-class-a","anvur-scientific","cwts-core","dongbi-b","doyens","jufo-3","ki-jl-2","medline","norway-2","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"SPINE","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5109102000","display_name":"Manohar M. Panjabi","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I32971472","display_name":"Yale University","ror":"https://ror.org/03v76x132","country_code":"US","type":"education","lineage":["https://openalex.org/I32971472"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Manohar M. Panjabi","raw_affiliation_strings":["Biomechanics Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Biomechanics Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut","institution_ids":["https://openalex.org/I32971472"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5109416658","display_name":"Chris Lydon","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I32971472","display_name":"Yale University","ror":"https://ror.org/03v76x132","country_code":"US","type":"education","lineage":["https://openalex.org/I32971472"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Chris Lydon","raw_affiliation_strings":["Biomechanics Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Biomechanics Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut","institution_ids":["https://openalex.org/I32971472"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5088826226","display_name":"Anita N. Vasavada","orcid":"https://orcid.org/0000-0003-2537-9590","observed_orcids":["https://orcid.org/0000-0003-2537-9590"]},"institutions":[{"id":"https://openalex.org/I32971472","display_name":"Yale University","ror":"https://ror.org/03v76x132","country_code":"US","type":"education","lineage":["https://openalex.org/I32971472"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Anita Vasavada","raw_affiliation_strings":["Biomechanics Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Biomechanics Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut","institution_ids":["https://openalex.org/I32971472"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5103385303","display_name":"Dieter Grob","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210112317","display_name":"Schulthess-Klinik","ror":"https://ror.org/01xm3qq33","country_code":"CH","type":"healthcare","lineage":["https://openalex.org/I4210112317"]}],"countries":["CH"],"is_corresponding":false,"raw_author_name":"Dieter Grob","raw_affiliation_strings":["Spine Unit, Wilhelm Schulthess Hospital, Z\u00fcrich, Switzerland"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Spine Unit, Wilhelm Schulthess Hospital, Z\u00fcrich, Switzerland","institution_ids":["https://openalex.org/I4210112317"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5019062338","display_name":"Joseph John Crisco","orcid":"https://orcid.org/0000-0002-8786-0905","observed_orcids":["https://orcid.org/0000-0002-8786-0905"]},"institutions":[{"id":"https://openalex.org/I32971472","display_name":"Yale University","ror":"https://ror.org/03v76x132","country_code":"US","type":"education","lineage":["https://openalex.org/I32971472"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Joseph J. Crisco","raw_affiliation_strings":["Biomechanics Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Biomechanics Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut","institution_ids":["https://openalex.org/I32971472"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5053030261","display_name":"Ji\u0159\u00ed Dvo\u0159\u00e1k","orcid":"https://orcid.org/0000-0002-2178-2326","observed_orcids":["https://orcid.org/0000-0002-2178-2326"]},"institutions":[{"id":"https://openalex.org/I4210112317","display_name":"Schulthess-Klinik","ror":"https://ror.org/01xm3qq33","country_code":"CH","type":"healthcare","lineage":["https://openalex.org/I4210112317"]}],"countries":["CH"],"is_corresponding":false,"raw_author_name":"Jiri Dvorak","raw_affiliation_strings":["Spine Unit, Wilhelm Schulthess Hospital, Z\u00fcrich, Switzerland"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Spine Unit, Wilhelm Schulthess Hospital, Z\u00fcrich, Switzerland","institution_ids":["https://openalex.org/I4210112317"]}]}],"institutions":[],"countries_distinct_count":2,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5019062338","https://openalex.org/A5088826226","https://openalex.org/A5109102000","https://openalex.org/A5109416658"],"corresponding_institution_ids":["https://openalex.org/I32971472"],"apc_list":null,"apc_paid":null,"fwci":2.1743,"has_fulltext":false,"cited_by_count":128,"citation_normalized_percentile":{"value":0.87967483,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":{"min":89,"max":99},"biblio":{"volume":"19","issue":"23","first_page":"2642","last_page":"2650"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10776","display_name":"Spinal Fractures and Fixation Techniques","score":0.9419000148773193,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10776","display_name":"Spinal Fractures and Fixation Techniques","score":0.9419000148773193,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11518","display_name":"Cervical and Thoracic Myelopathy","score":0.04259999841451645,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12249","display_name":"Veterinary Orthopedics and Neurology","score":0.0034000000450760126,"subfield":{"id":"https://openalex.org/subfields/3404","display_name":"Small Animals"},"field":{"id":"https://openalex.org/fields/34","display_name":"Veterinary"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/cervical-instability","display_name":"cervical spine instability","score":0.7820000052452087},{"id":"https://openalex.org/keywords/cervical-range-of-motion","display_name":"cervical range of motion","score":0.6520000100135803},{"id":"https://openalex.org/keywords/neutral-zone","display_name":"neutral zone","score":0.902999997138977},{"id":"https://openalex.org/keywords/intervertebral-motion","display_name":"intervertebral motion","score":0.7829999923706055},{"id":"https://openalex.org/keywords/spine-biomechanics","display_name":"spinal biomechanics","score":0.6990000009536743},{"id":"https://openalex.org/keywords/cadaveric-cervical-spine","display_name":"cadaveric cervical spine","score":0.765999972820282}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9427403211593628},{"id":"https://openalex.org/C207821765","wikidata":"https://www.wikidata.org/wiki/Q405372","display_name":"Instability","level":2,"score":0.5718520283699036},{"id":"https://openalex.org/C57879066","wikidata":"https://www.wikidata.org/wiki/Q41217","display_name":"Mechanics","level":1,"score":0.06218937039375305},{"id":"https://openalex.org/C121332964","wikidata":"https://www.wikidata.org/wiki/Q413","display_name":"Physics","level":0,"score":0.0}],"mesh":[{"descriptor_ui":"D000328","descriptor_name":"Adult","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D001696","descriptor_name":"Biomechanical Phenomena","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D002574","descriptor_name":"Cervical Vertebrae","qualifier_ui":"Q000601","qualifier_name":"surgery","is_major_topic":true},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007593","descriptor_name":"Joint Instability","qualifier_ui":"Q000601","qualifier_name":"surgery","is_major_topic":true},{"descriptor_ui":"D007593","descriptor_name":"Joint Instability","qualifier_ui":"Q000628","qualifier_name":"therapy","is_major_topic":true},{"descriptor_ui":"D008297","descriptor_name":"Male","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008875","descriptor_name":"Middle Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D010146","descriptor_name":"Pain","qualifier_ui":"Q000175","qualifier_name":"diagnosis","is_major_topic":false},{"descriptor_ui":"D016267","descriptor_name":"External Fixators","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D059408","descriptor_name":"Pain Management","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false}],"locations_count":3,"locations":[{"id":"doi:10.1097/00007632-199412000-00008","doi":"https://doi.org/10.1097/00007632-199412000-00008","is_oa":false,"landing_page_url":"https://doi.org/10.1097/00007632-199412000-00008","pdf_url":null,"source":{"id":"https://openalex.org/S4026894","display_name":"Spine","issn_l":"0362-2436","issn":["0362-2436","1528-1159"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-class-a","anvur-scientific","cwts-core","dongbi-b","doyens","jufo-3","ki-jl-2","medline","norway-2","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"SPINE","raw_type":"journal-article"},{"id":"doi:10.1097/00007632-199412010-00008","doi":"https://doi.org/10.1097/00007632-199412010-00008","is_oa":false,"landing_page_url":"https://doi.org/10.1097/00007632-199412010-00008","pdf_url":null,"source":{"id":"https://openalex.org/S4026894","display_name":"Spine","issn_l":"0362-2436","issn":["0362-2436","1528-1159"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-class-a","anvur-scientific","cwts-core","dongbi-b","doyens","jufo-3","ki-jl-2","medline","norway-2","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Spine","raw_type":"journal-article"},{"id":"pmid:7899958","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/7899958","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Spine","raw_type":"Journal Article"}],"best_oa_location":null,"sustainable_development_goals":[{"score":0.8999999761581421,"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being"}],"study_designs":[],"awards":[{"id":"https://openalex.org/G847169785","display_name":null,"funder_award_id":"AR-42211","funder_id":"https://openalex.org/F4320337362","funder_display_name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases"}],"funders":[{"id":"https://openalex.org/F4320337362","display_name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","ror":"https://ror.org/006zn3t30"}],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W2440744798","https://openalex.org/W2024383924","https://openalex.org/W2061864256","https://openalex.org/W2354038702","https://openalex.org/W2021404849","https://openalex.org/W2356698405","https://openalex.org/W2317213512","https://openalex.org/W63612429","https://openalex.org/W2413735351","https://openalex.org/W2354473341"],"abstract_inverted_index":{"STUDY":[0],"DESIGN:":[1],"Three-dimensional":[2],"flexibility":[3,67],"changes":[4,53],"due":[5],"to":[6,33,155,174],"the":[7,24,49,52,77,120,149,168,175,179,198,202,206,209,217,222],"application":[8,79,169],"of":[9,27,89,119,170,201,224],"an":[10,37,171],"external":[11,31,172],"fixator":[12,32,78,121,173],"at":[13,70,80,151,159],"C4-C5":[14,152],"were":[15,99,127,153],"studied":[16],"in":[17,38,54,163,182,192],"cervical":[18,30,176],"spine":[19,177,203],"specimens.":[20],"OBJECTIVES:":[21],"To":[22],"evaluate":[23],"biomechanical":[25],"effects":[26],"applying":[28],"a":[29,34],"patient":[35],"using":[36],"vitro":[39,164],"model.":[40],"SUMMARY":[41],"OF":[42],"BACKGROUND":[43],"DATA:":[44],"There":[45],"is":[46,212,221],"controversy":[47],"regarding":[48],"relationship":[50],"between":[51],"spinal":[55],"motion":[56,90,181],"and":[57,75,83,96,106,115,134,143,184,188,204],"clinical":[58,199,218],"instability.":[59],"METHODS:":[60],"Using":[61],"fresh":[62],"cadaveric":[63],"C4-C7":[64],"specimens,":[65],"multidirectional":[66],"was":[68],"measured":[69],"all":[71],"vertebral":[72],"levels,":[73],"before":[74],"after":[76],"C4-C5,":[81],"C5-C6,":[82],"C4-C6.":[84],"RESULTS:":[85],"The":[86,123,146,194],"average":[87],"ranges":[88],"for":[91,157],"flexion,":[92,186],"extension,":[93],"lateral":[94],"bending,":[95],"axial":[97],"rotation":[98],"8.3":[100],"degrees,":[101,103,105,108,129,131,133,136],"7.2":[102],"5.3":[104],"5.6":[107],"which":[109,137],"decreased":[110,138],"by":[111,139],"40%,":[112],"27%,":[113],"32%,":[114],"58%,":[116],"respectively,":[117],"because":[118],"application.":[122],"corresponding":[124],"neutral":[125,190,210],"zones":[126,191],"3.4":[128,130],"3.0":[132],"2.0":[135],"76%,":[140,141],"54%":[142],"69%,":[144],"respectively.":[145],"decreases":[147,178,185],"with":[148,216],"fixation":[150,158],"similar":[154],"those":[156],"C5-C6.":[160],"CONCLUSIONS:":[161],"This":[162],"study":[165],"documented":[166],"that":[167,208],"intervertebral":[180],"general,":[183],"extension":[187],"torsional":[189],"particular.":[193],"findings":[195],"help":[196],"explain":[197],"instability":[200,219],"support":[205],"hypothesis":[207],"zone":[211],"more":[213],"closely":[214],"associated":[215],"than":[220],"range":[223],"motion.":[225]},"counts_by_year":[{"year":2026,"cited_by_count":3},{"year":2025,"cited_by_count":5},{"year":2024,"cited_by_count":1},{"year":2023,"cited_by_count":10},{"year":2022,"cited_by_count":4},{"year":2021,"cited_by_count":3},{"year":2020,"cited_by_count":6},{"year":2019,"cited_by_count":1},{"year":2018,"cited_by_count":3},{"year":2017,"cited_by_count":4},{"year":2016,"cited_by_count":2},{"year":2015,"cited_by_count":3},{"year":2014,"cited_by_count":3},{"year":2013,"cited_by_count":5},{"year":2012,"cited_by_count":5}],"updated_date":"2026-10-31T12:09:11.096373","created_date":"2016-06-24T00:00:00"}