Bakhtadze Maxim A, Vernon Howard, Karalkin Anatoliy V, Pasha Sergey P, Tomashevskiy Igor O, Soave David
Center for Manual Therapy, Moscow, Russia.
J Manipulative Physiol Ther. 2012 Feb;35(2):76-85. doi: 10.1016/j.jmpt.2011.12.006. Epub 2012 Jan 16.
The purpose of this study was to determine the correlation between cerebral perfusion levels, Neck Disability Index (NDI) scores, and spinal joint fixations in patients with neck pain.
Forty-five adult patients (29 were female) with chronic neck/upper thoracic pain during exacerbation were studied. The subjects were grouped according to NDI scores: mild, moderate, and severe. The number of painful/blocked segments in the cervical and upper thoracic spine and costovertebral joints, pain intensity using the visual analog scale, and regional cerebral blood flow of the brain using single-photon emission computed tomography (SPECT) were obtained. The SPECT was analyzed semiquantitatively. Analysis of variance tests were conducted on total SPECT scores in each of the NDI groups (P < .05). Univariate correlations were obtained between blockage, pain, and SPECT scores, as well as age and duration. A multivariate analysis was then conducted.
Group 1 (mild) consisted of 14 patients. Cerebral perfusion measured by SPECT was normal in all 8 brain regions. Group 2 (moderate) consisted of 16 patients. In this group, a decrease in cerebral perfusion was observed (range, 20%-35%), predominantly in the parietal and frontal zones. Group 3 (severe) consisted of 15 patients. In this group, the decrease in cerebral perfusion observed was from 30% to 45%, again predominantly in the parietal and frontal zones. A significant difference was found between NDI groups ("moderate" and "severe" showed significantly greater hypoperfusion than "mild"). Total blockage score correlated with SPECT scores at r = 0.47, P = .001. In a multivariate analysis, NDI scores contributed 39% of the variance of SPECT scores.
In this group of patients with neck and/or upper back pain, NDI scores strongly predicted cerebral hypoperfusion. Spinal joint dysfunction may be involved via hyperactivity in the regional sympathetic nervous system.
本研究旨在确定颈部疼痛患者的脑灌注水平、颈部功能障碍指数（NDI）评分与脊柱关节固定之间的相关性。
对45例成年患者（29例女性）进行研究，这些患者在病情加重时患有慢性颈部/上胸部疼痛。根据NDI评分将受试者分为轻度、中度和重度三组。记录颈椎和上胸椎及肋椎关节疼痛/阻滞节段的数量、使用视觉模拟量表评估的疼痛强度以及使用单光子发射计算机断层扫描（SPECT）测量的脑局部血流。对SPECT进行半定量分析。对各NDI组的SPECT总分进行方差分析（P < 0.05）。分析阻滞、疼痛与SPECT评分之间以及年龄和病程之间的单变量相关性。然后进行多变量分析。
第1组（轻度）有14例患者。SPECT测量的所有8个脑区的脑灌注均正常。第2组（中度）有16例患者。该组观察到脑灌注下降（范围为20% - 35%），主要发生在顶叶和额叶区域。第3组（重度）有15例患者。该组观察到脑灌注下降30%至45%，同样主要发生在顶叶和额叶区域。NDI组之间存在显著差异（“中度”和“重度”组的灌注不足明显高于“轻度”组）。总阻滞评分与SPECT评分的相关性为r = 0.47，P = 0.001。在多变量分析中，NDI评分占SPECT评分方差的39%。
在这组颈部和/或上背部疼痛的患者中，NDI评分强烈预测脑灌注不足。脊柱关节功能障碍可能通过局部交感神经系统的过度活动参与其中。
