McGregor A H, Cattermole H R, Hughes S P
Imperial College School of Medicine, Charing Cross Hospital, London, UK.
Spine (Phila Pa 1976). 2001 Feb 1;26(3):282-6. doi: 10.1097/00007632-200102010-00013.
This was a prospective pilot study to investigate the global motion characteristics of the spondylolysis and spondylolisthesis populations.
The aim of this study is to determine the influence of a spondylolisthesis or a spondylolysis on global spinal motion and to establish whether this is dependent on the cause of the slip or the degree/grade of the slip.
The condition of spondylolisthesis has been extensively discussed in the literature with respect to its etiology and management. However, the mechanics and movement of the spine in relation to pathology and the effect of this condition on function have received scant attention.
The motion of the lumbar spine was investigated in 31 patients (19 men, 12 women, mean age 47.7 +/- 17.8 years) who were diagnosed as having either a lumbar spondylolysis or a spondylolisthesis. These patients were compared with a preexisting database of 203 normal subjects (100 men, 103 women, mean age 39.8 +/- 13.4 years). Patients were graded according to the type of spondylolisthesis or spondylolysis they had, and the extent of slip was rated using Meyerding's classification (1932) and measured directly using methods of Boxall et al (1979) and Wiltse et al (1983).
Direct measurements of the extent of slip using Boxall et al (1979) and Wiltse et al (1983) methods were found to have no significant correlation with the resultant range of motion (ROM) or the speed of movement. This study suggests that motion parameters are influenced by the grade of slip in patients with spondylolisthesis, and the type of spondylolisthesis i.e., whether isthmic or degenerative. In the A-P flexion-extension plane, the results indicate that subjects with a defect only, i.e., a spondylolysis, and thus no slip present with a spinal hypermobility (P < 0.01). Subjects with an isthmic slip tend to be either slightly hypermobile or within the anticipated range of motion, whereas those subjects with a degenerative slip tend to be hypomobile (P < 0.05). Movements into lateral flexion were restricted in both the isthmic and degenerative spondylolisthesis patients, whereas rotation was only influenced by the level at which the defect occurred. In terms of degree of displacement, in higher grades of displacement, there was a trend towards hypermobility.
The findings of this study suggest that the grade and type of spondylolisthesis do influence global motion parameters. This information may be useful in the clinical assessment of this patient group.
这是一项前瞻性试点研究，旨在调查椎弓根峡部裂和腰椎滑脱人群的整体运动特征。
本研究的目的是确定腰椎滑脱或椎弓根峡部裂对脊柱整体运动的影响，并确定这是否取决于滑脱的原因或滑脱的程度/分级。
关于腰椎滑脱的病因和治疗，文献中已有广泛讨论。然而，脊柱在病理状态下的力学和运动以及这种情况对功能的影响却很少受到关注。
对31例被诊断为腰椎椎弓根峡部裂或腰椎滑脱的患者（19例男性，12例女性，平均年龄47.7±17.8岁）的腰椎运动进行了研究。将这些患者与一个已有的包含203名正常受试者（100例男性，103例女性，平均年龄39.8±13.4岁）的数据库进行比较。根据患者所患椎弓根峡部裂或腰椎滑脱的类型对患者进行分级，并使用迈耶丁分类法（1932年）对滑脱程度进行评估，并直接采用博克索尔等人（1979年）和威尔茨等人（1983年）的方法进行测量。
采用博克索尔等人（1979年）和威尔茨等人（1983年）的方法对滑脱程度进行直接测量，发现与最终的活动范围（ROM）或运动速度没有显著相关性。本研究表明，运动参数受腰椎滑脱患者滑脱程度以及腰椎滑脱类型（即峡部型或退变型）的影响。在前后屈伸平面上，结果表明，仅患有椎弓根峡部裂（即无滑脱）的受试者脊柱活动度增加（P<0.01）。峡部型滑脱的受试者往往活动度略有增加或在预期的运动范围内，而退变型滑脱的受试者往往活动度降低（P<0.05）。峡部型和退变型腰椎滑脱患者向侧方弯曲的运动均受限，而旋转仅受缺损发生水平的影响。就移位程度而言，在较高等级的移位中，存在活动度增加的趋势。
本研究结果表明，腰椎滑脱的分级和类型确实会影响整体运动参数。这些信息可能对该患者群体的临床评估有用。
