Abbott J Haxby, Fritz Julie M, McCane Brendan, Shultz Barry, Herbison Peter, Lyons Brett, Stefanko Georgia, Walsh Richard M
Clarity Clinical Research Consultants, Dunedin, New Zealand.
BMC Musculoskelet Disord. 2006 May 19;7:45. doi: 10.1186/1471-2474-7-45.
Lumbar segmental rigidity (LSR) and lumbar segmental instability (LSI) are believed to be associated with low back pain (LBP), and identification of these disorders is believed to be useful for directing intervention choices. Previous studies have focussed on lumbar segmental rotation and translation, but have used widely varying methodologies. Cut-off points for the diagnosis of LSR & LSI are largely arbitrary. Prevalence of these lumbar segmental mobility disorders (LSMDs) in a non-surgical, primary care LBP population has not been established.
A cohort of 138 consecutive patients with recurrent or chronic low back pain (RCLBP) were recruited in this prospective, pragmatic, multi-centre study. Consenting patients completed pain and disability rating instruments, and were referred for flexion-extension radiographs. Sagittal angular rotation and sagittal translation of each lumbar spinal motion segment was measured from the radiographs, and compared to a reference range derived from a study of 30 asymptomatic volunteers. In order to define reference intervals for normal motion, and define LSR and LSI, we approached the kinematic data using two different models. The first model used a conventional Gaussian definition, with motion beyond two standard deviations (2sd) from the reference mean at each segment considered diagnostic of rotational LSMD and translational LSMD. The second model used a novel normalised within-subjects approach, based on mean normalised contribution-to-total-lumbar-motion. An LSMD was then defined as present in any segment that contributed motion beyond 2sd from the reference mean contribution-to-normalised-total-lumbar-motion. We described reference intervals for normal segmental mobility, prevalence of LSMDs under each model, and the association of LSMDs with pain and disability.
With the exception of the conventional Gaussian definition of rotational LSI, LSMDs were found in statistically significant prevalences in patients with RCLBP. Prevalences at both the segmental and patient level were generally higher using the normalised within-subjects model (2.8 to 16.8% of segments; 23.3 to 35.5% of individuals) compared to the conventional Gaussian model (0 to 15.8%; 4.7 to 19.6%). LSMDs are associated with presence of LBP, however LSMDs do not appear to be strongly associated with higher levels of pain or disability compared to other forms of non-specific LBP.
LSMDs are a valid means of defining sub-groups within non-specific LBP, in a conservative care population of patients with RCLBP. Prevalence was higher using the normalised within-subjects contribution-to-total-lumbar-motion approach.
腰椎节段性僵硬（LSR）和腰椎节段性不稳定（LSI）被认为与腰痛（LBP）相关，并且认为识别这些病症有助于指导干预选择。先前的研究主要集中在腰椎节段的旋转和平移，但所使用的方法差异很大。LSR和LSI诊断的截断点在很大程度上是任意的。在非手术的初级护理腰痛患者人群中，这些腰椎节段性活动障碍（LSMD）的患病率尚未确定。
在这项前瞻性、实用性、多中心研究中，招募了138例连续的复发性或慢性腰痛（RCLBP）患者。同意参与的患者完成疼痛和残疾评定量表，并被转诊进行屈伸位X线片检查。从X线片中测量每个腰椎运动节段的矢状角旋转和矢状平移，并与来自30名无症状志愿者研究得出的参考范围进行比较。为了定义正常运动的参考区间，并定义LSR和LSI，我们使用两种不同的模型处理运动学数据。第一个模型使用传统的高斯定义，每个节段的运动超出参考均值两个标准差（2sd）被认为是旋转性LSMD和平移性LSMD的诊断标准。第二个模型使用一种新的受试者内归一化方法，基于对总腰椎运动的平均归一化贡献。然后将LSMD定义为在任何一个节段中存在，该节段对归一化总腰椎运动的贡献超出参考均值2sd。我们描述了正常节段性活动的参考区间、每个模型下LSMD的患病率，以及LSMD与疼痛和残疾的关联。
除了传统高斯定义的旋转性LSI外，RCLBP患者中LSMD的患病率具有统计学意义。与传统高斯模型（0至15.8%；4.7至19.6%）相比，使用受试者内归一化模型时，节段和患者水平的患病率通常更高（节段的2.8%至16.8%；个体的23.3%至35.5%）。LSMD与LBP的存在相关，然而与其他形式的非特异性LBP相比，LSMD似乎与更高水平的疼痛或残疾没有强烈关联。
在RCLBP的保守治疗患者人群中，LSMD是定义非特异性LBP亚组的有效手段。使用受试者内对总腰椎运动的归一化贡献方法时患病率更高。
