Physical Medicine and Rehabilitation, University of Michigan Health System, 325 E. Eisenhower, Suite 200, Ann Arbor, MI 48108, USA.
PM R. 2013 Jan;5(1):39-44. doi: 10.1016/j.pmrj.2012.08.017.
To determine the relationship among spinal stenosis, back pain, paraspinal muscle denervation, and paraspinal muscle atrophy.
A prospective masked, double-controlled study.
A university hospital and outpatient spine clinic.
Ten asymptomatic subjects, 10 subjects with mechanical low back pain, and 15 subjects with symptomatic spinal stenosis; age range, 55-80 years old.
Magnetic resonance imaging measurements of minimum spinal canal diameter, paraspinal muscle cross-sectional area at the level of the L5-S1 disk, and quantified paraspinal electrodiagnostic testing (MiniPM) were performed by examiners blinded to each other's results and to the participants' clinical information.
Paraspinal muscle cross-sectional area and MiniPM scores.
A paraspinal cross-sectional area decreased significantly from asymptomatic subjects (3872 mm(2)) to subjects with low back pain (3627 mm(2)) and to subjects with spinal stenosis (2985 mm(2)). In the stenosis group, there was a trend toward increased paraspinal denervation in the subjects with severe spinal stenosis, but this was not statistically significant.
Symptomatic spinal stenosis results in greater paraspinal muscle atrophy than low back pain alone. The extent of paraspinal atrophy was not significantly explained by the extent of denervation, thus, it may be reversible, and the role of paraspinal muscle rehabilitation in patients with spinal stenosis deserves further study.
确定椎管狭窄、腰痛、腰背肌失神经支配和腰背肌萎缩之间的关系。
前瞻性、盲法、双对照研究。
一所大学医院和门诊脊柱诊所。
10 名无症状受试者、10 名机械性腰痛受试者和 15 名有症状椎管狭窄受试者；年龄范围 55-80 岁。
通过彼此的结果和参与者的临床信息均不知情的检查者进行磁共振成像测量最小椎管直径、L5-S1 椎间盘水平的腰背肌横截面积和量化的腰背肌电诊断测试（MiniPM）。
腰背肌横截面积和 MiniPM 评分。
从无症状受试者（3872mm2）到腰痛受试者（3627mm2）和椎管狭窄受试者（2985mm2），腰背肌横截面积显著减小。在狭窄组中，严重椎管狭窄患者的腰背肌失神经支配呈增加趋势，但无统计学意义。
症状性椎管狭窄导致的腰背肌萎缩比单纯腰痛更为严重。腰背肌萎缩的程度不能用失神经支配的程度来很好地解释，因此，它可能是可以逆转的，腰背肌康复在椎管狭窄患者中的作用值得进一步研究。
