Mayer T G, Robinson R, Pegues P, Kohles S, Gatchel R J
Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, USA.
Arch Phys Med Rehabil. 2000 Sep;81(9):1143-50. doi: 10.1053/apmr.2000.9170.
To describe a method for observing lumbar segmental rigidity and to show how motion measurements and pain/disability questionnaires can be used to evaluate outcomes of combined facet injections and stretching exercises.
Preliminary 2-part study: (1) presentation of a technique for, identifying lumbar segmental rigidity based on physical observation of the spine's lateral bending; and (2) repeated measures of motion and pain/disability self-report in a chronic lumbar spinal disorder cohort, performed before and after treatment with combined facet injections and stretching exercises.
An outpatient tertiary rehabilitation facility providing interdisciplinary functional restoration for chronic disabling work-related spinal disorders.
Chronically disabled patients with lumbar spinal disorder (n = 39; mean age, 41yr; 82% male) with segmental rigidity at 1 or more levels on physical examination. Subjects averaged 20 months of disability, and 51% had preinjection spine surgery (average, 1.7 procedures involving up to 3 spinal segments). Thirty-nine percent of the cohort had a fusion at levels 1 or 2.
Bilateral facet injections were administered under fluoroscopy to all patients, and 2 or 3 levels were performed in 93% of cases (range, levels 1-4). Patients were instructed in an unsupervised stretching program and were reassessed 2 to 4 weeks later. After an intensive supervised resistance exercise training program as part of interdisciplinary functional restoration, a third set of motion, pain, and disability measures were collected.
Changes in true lumbar sagittal and coronal motion (T12-S1), measured with inclinometers, and pain/disability self-report were compared statistically.
Patients' mobility improved significantly (p < .01-.0001) across all 4 motions. A large majority (71%-97%) of individuals improved on motion. According to self-reports made over the postinjection period, most patients improved their disability (83%) and pain intensity (63%) ratings.
A simple physical examination technique for assessing lumbar spine segmental rigidity was used in this preliminary study to select patients and levels for combined facet injection and stretching exercise, with resultant improvements in mobility and self-reported pain/disability that may extend beyond the pharmacologic duration of the corticosteroid. The efficacy of either the facet injection or stretching components alone in achieving objective mobility improvements cannot be determined from the present study, but warrants future investigation.
描述一种观察腰椎节段僵硬的方法，并展示运动测量和疼痛/功能障碍问卷如何用于评估联合小关节注射和伸展运动的效果。
初步的两部分研究：（1）介绍一种基于对脊柱侧屈的体格观察来识别腰椎节段僵硬的技术；（2）在慢性腰椎疾病队列中，在联合小关节注射和伸展运动治疗前后，对运动和疼痛/功能障碍的自我报告进行重复测量。
一家为慢性致残性工作相关脊柱疾病提供跨学科功能恢复的门诊三级康复机构。
患有腰椎疾病的慢性残疾患者（n = 39；平均年龄41岁；82%为男性），体格检查发现1个或更多节段存在节段僵硬。受试者平均残疾20个月，51%的患者在注射前接受过脊柱手术（平均1.7次手术，涉及多达3个脊柱节段）。39%的队列患者在L1或L2节段有融合。
在透视引导下对所有患者进行双侧小关节注射，93%的病例进行2或3个节段的注射（范围为L1 - L4节段）。指导患者进行无监督的伸展计划，并在2至4周后进行重新评估。作为跨学科功能恢复的一部分，在强化监督的阻力运动训练计划后，收集第三组运动、疼痛和功能障碍测量数据。
用倾角仪测量的真实腰椎矢状面和冠状面运动（T12 - S1）的变化以及疼痛/功能障碍的自我报告进行统计学比较。
所有4项运动中患者的活动度均有显著改善（p <.01 -.0001）。绝大多数（71% - 97%）个体的运动得到改善。根据注射后期间的自我报告，大多数患者的功能障碍（83%）和疼痛强度（63%）评分有所改善。
在这项初步研究中，使用了一种简单的体格检查技术来评估腰椎节段僵硬，以选择患者和节段进行联合小关节注射和伸展运动，结果活动度以及自我报告的疼痛/功能障碍得到改善，且改善可能超出皮质类固醇的药理作用持续时间。本研究无法确定单独的小关节注射或伸展运动成分在实现客观活动度改善方面的疗效，但值得未来进一步研究。
