Department of Orthopedic Surgery, Baylor College of Medicine, 6620 Main St, 12th Floor, Houston, TX 77030, USA.
Spine J. 2011 Apr;11(4):336-9. doi: 10.1016/j.spinee.2011.02.005.
Traumatic injury to the lumbar spine is evaluated and treated based on the perceived stability of the spine. Recent classification schemes have established the importance of evaluating the posterior ligamentous complex (PLC) to fully comprehend stability. There are a variety of techniques to evaluate the PLC, including assessment of interspinous distance. However reference data to define normal widening are poorly developed.
Define normal interspinous widening in the lumbar spine.
Biomechanical and observational. To establish reference data for asymptomatic population and use the reference data to suggest criteria for routine clinical practice to be validated in future studies.
Interspinous distances were measured from lateral lumbar X-rays of 157 asymptomatic volunteers. Measurements from the asymptomatic population were used to define normal limits and create a simple screening tool for clinical use. Distances were calculated from the relative position of landmarks at each intervertebral level. The distances were normalized to the anterior-posterior width of the superior end plate of L3. The change in interspinous process distance from flexion to extension was calculated, and the change in interspinous widening between flexion and extension with respect to widening at the adjacent levels was also calculated.
Seven hundred seventy-two thoracolumbar levels were available for analysis. The observed interspinous motion was slightly more than the interlaminar motion. However, the tips of the spinous processes were more difficult to identify in some images, so the interlaminar line distances were considered more reliable. Significant difference in interlaminar distances was not found between levels. The upper limit (UL) of normal spacing measured between the interlaminar lines was approximately 85% of the L3 end plate width at all levels except L5-S1, which was 105%. The UL of normal for interlaminar displacements between flexion and extension was 30% of the L3 end plate width at L1-L2 to L4-L5 and 40% at L5-S1.
This study provides normative data and methods that can be used in developing guidelines to objectively assess interspinous process widening. Simple rules can be applied to quickly assess interspinous widening. Additional research is required to validate these guidelines. A simple measurement such as spinous process widening is unlikely to be proven as an isolated clinically effective screening test but combining that with other patient evaluation's screening modalities may prove to be a sensitive evaluation protocol for the screening of injuries to the PLC.
腰椎创伤的评估和治疗基于脊柱稳定性的感知。最近的分类方案已经确定了评估后韧带复合体（PLC）以全面了解稳定性的重要性。有多种技术可以评估 PLC，包括评估棘突间距离。然而，定义正常增宽的参考数据尚未得到充分发展。
定义腰椎中棘突间正常增宽。
生物力学和观察性。为了为无症状人群建立参考数据，并使用参考数据为常规临床实践建议标准，以便在未来的研究中进行验证。
从 157 名无症状志愿者的侧位腰椎 X 光片中测量棘突间距离。使用无症状人群的测量值来定义正常范围，并创建一个简单的筛查工具，供临床使用。距离是从每个椎间水平的标志点的相对位置计算得出的。距离是根据 L3 上终板的前后宽度进行归一化的。从屈曲到伸展计算棘突间距离的变化，并且还计算屈曲和伸展时相对于相邻水平的棘突间增宽的变化。
772 个胸腰椎水平可用于分析。观察到的棘突间运动略大于层间运动。然而，在某些图像中，棘突尖端更难识别，因此认为层间线距离更可靠。在各水平之间，层间距离没有发现显著差异。在所有水平（除了 L5-S1，为 105%），测量的层间线之间的正常间隔上限（UL）约为 L3 终板宽度的 85%。屈曲和伸展之间的正常层间位移的 UL 为 L1-L2 到 L4-L5 的 L3 终板宽度的 30%，L5-S1 的为 40%。
本研究提供了可以用于制定客观评估棘突间过程增宽的指南的正常数据和方法。可以应用简单的规则来快速评估棘突间增宽。需要进一步研究来验证这些指南。简单的测量，如棘突间增宽，不太可能被证明是一种孤立的临床有效筛查试验，但将其与其他患者评估的筛查模式相结合，可能成为 PLC 损伤筛查的敏感评估方案。
