Rühli Frank J, Henneberg Maciej
Clinical Paleopathology Unit, Orthopedic University Clinic Balgrist and Institute for the History of Medicine, University of Zurich, Hirschengraben 82, 8001, Zurich, Switzerland.
Eur Spine J. 2004 Dec;13(8):733-9. doi: 10.1007/s00586-004-0682-8. Epub 2004 Apr 1.
Low back pain origins have been a matter of great controversy. While spinal stenosis is now radiologically traceable, the alteration of intervertebral foramen is less clear. The aim of this study was to assess "secular trends"-alterations occurring from one generation to the next-in osseous intervertebral foramina of the major vertebral segments in an industrialized society, and to discuss their possible clinical implication. The macerated "maximum intervertebral foramen width" and "intervertebral foramen height" of all major vertebral levels in 71 non-pathologic Swiss adult skeletons from the nineteenth and early twentieth century, with known individual age and sex and similar geographic and socio-economic background, were measured by sliding caliper at validated landmarks. A secular trend of the increase in "maximum intervertebral foramen width" is found for most levels, with females showing a more prominent alteration. Additionally, the non-pathologic "maximum intervertebral foramen width" does not change with respect to individual age, nor is a significant side difference detectable. "Intervertebral foramen height," hereby defined as the difference of the dorsal vertebral body height minus pedicle height, demonstrates for most levels, and either sex, an insignificant negative secular trend. Neither stature nor skeletal robustness vary significantly through time within this particular sample. The results of this study, despite obvious inadequacies of methods used, exclude secular narrowing of the "maximum intervertebral foramen width" as the only cause of radiculopathy or spinal stenosis. Furthermore, we found a mild insignificant decrease of the clinically more relevant "intervertebral foramen height." Nevertheless, the detected short-time variability of the bony intervertebral foramen, independent of individual stature, skeletal robustness or age, argues for an enhanced focus on the understanding of clinically relevant changes of spinal morphology from generation to generation.
下背痛的起源一直是一个极具争议的问题。虽然现在可以通过影像学追踪到椎管狭窄，但椎间孔的改变却不太清楚。本研究的目的是评估工业化社会中主要椎体节段的骨性椎间孔从一代到下一代发生的“长期趋势”——变化情况，并讨论其可能的临床意义。通过游标卡尺在经过验证的标志点测量了来自19世纪和20世纪初的71具非病理性瑞士成人骨骼所有主要椎体水平的浸软后的“最大椎间孔宽度”和“椎间孔高度”，这些骨骼的个体年龄、性别已知，地理和社会经济背景相似。发现大多数水平的“最大椎间孔宽度”存在增加的长期趋势，女性的改变更为明显。此外，非病理性的“最大椎间孔宽度”不随个体年龄变化，也未检测到明显的左右差异。“椎间孔高度”在此定义为椎体背侧高度减去椎弓根高度的差值，在大多数水平上，无论男女，均呈现出不显著的负向长期趋势。在这个特定样本中，身高和骨骼粗壮程度随时间均无显著变化。尽管所用方法存在明显不足，但本研究结果排除了“最大椎间孔宽度”的长期变窄是神经根病或椎管狭窄的唯一原因。此外，我们发现临床上更相关的“椎间孔高度”有轻微的不显著下降。然而，检测到的骨性椎间孔的短期变异性，独立于个体身高、骨骼粗壮程度或年龄，这表明需要更加关注对脊柱形态在代际间临床相关变化的理解。
