Takasaki Hiroshi, May Stephen, Fazey Peter J, Hall Toby
Division of Physiotherapy, School of Health and Rehabilitation Science, The University of Queensland, Australia.
J Man Manip Ther. 2010 Sep;18(3):153-8. doi: 10.1179/106698110X12640740712455.
The McKenzie management strategy of mechanical diagnosis and therapy (MDT) is commonly used for the assessment and management of spinal problems. Within this system, 'derangement syndrome' is the most common classification, for which the conceptual model is an intra-discal displacement. However, the reduction of an intra-discal displacement by MDT has never been documented. The purpose of this study was to compare, using magnetic resonance imaging (MRI), the nucleus pulposus (NP) profiles before and after the use of this approach.
The patient was a 34-year-old female with a long history of right sided low back and buttock pain classified with 'derangement syndrome'.
T2-weighted images of the L4-5 disc at initial assessment were compared with that at final assessment 1 month later. Initially, the MRI showed a portion of the NP displaced right and posteriorly towards the side of pain, and an overall NP position in the coronal plane shifted to the left.
The patient was managed with a 1-month course of the McKenzie management strategy treatment.
One month later, the displaced portion of the NP was no longer present and the left-shifted NP was centrally located.
These intervertebral disc changes coincided with centralization and abolition of symptoms. This case may support the conceptual model of MDT.
麦肯齐力学诊断与治疗（MDT）管理策略常用于脊柱问题的评估与管理。在该体系中，“紊乱综合征”是最常见的分类，其概念模型是椎间盘内移位。然而，MDT使椎间盘内移位复位的情况从未有过记录。本研究的目的是使用磁共振成像（MRI）比较采用该方法前后的髓核（NP）情况。
患者为一名34岁女性，有长期右侧腰臀部疼痛病史，诊断为“紊乱综合征”。
将初次评估时L4-5椎间盘的T2加权图像与1个月后最终评估时的图像进行比较。最初，MRI显示NP的一部分向右后方移位至疼痛侧，且NP在冠状面的整体位置向左偏移。
对患者采用为期1个月的麦肯齐管理策略治疗。
1个月后，NP移位部分消失，向左偏移的NP位于中央。
这些椎间盘变化与症状的集中化和消失相一致。该病例可能支持MDT的概念模型。
