Mellor Fiona E, Thomas Peter W, Thompson Paul, Breen Alan C
Institute for Musculoskeletal Research and Clinical Implementation, Anglo-European College of Chiropractic, Parkwood Road, Bournemouth, BH5 2DF, UK.
Eur Spine J. 2014 Oct;23(10):2059-67. doi: 10.1007/s00586-014-3273-3. Epub 2014 Mar 28.
Identifying biomechanical subgroups in chronic, non-specific low back pain (CNSLBP) populations from inter-vertebral displacements has proven elusive. Quantitative fluoroscopy (QF) has excellent repeatability and provides continuous standardised inter-vertebral kinematic data from fluoroscopic sequences allowing assessment of mid-range motion. The aim of this study was to determine whether proportional continuous IV rotational patterns were different in patients and controls. A secondary aim was to update the repeatability of QF measurement of range of motion (RoM) for inter-vertebral (IV) rotation.
Fluoroscopic sequences were recorded of passive, recumbent coronal and sagittal motion, which was controlled for range and velocity. Segments L2-5 in 40 primary care CNSLBP patients and 40 matched controls were compared. Patients also completed the von Korff Chronic Pain Grade and Roland and Morris Disability Questionnaire. Sequences were processed using automated image tracking algorithms to extract continuous inter-vertebral rotation data. These were converted to continuous proportional ranges of rotation (PR). The continuous proportional range variances were calculated for each direction and combined to produce a single variable representing their fluctuation (CPRV). Inter- and intra-rater repeatability were also calculated for the maximum IV-RoM measurements obtained during controlled trunk motion to provide an updated indication of the reliability and agreement of QF for measuring spine kinematics.
CPRV was significantly higher in patients (0.011 vs. 0.008, Mann-Whitney two-sided p = 0.008), implying a mechanical subgroup. Receiver operating characteristic curve analysis found its sensitivity and specificity to be 0.78 % (60-90) and 0.55 % (37-73), respectively (area under the curve 0.672). CPRV was not correlated with pain severity or disability. The repeatability of maximum inter-vertebral range was excellent, but range was only significantly greater in patients at L4-5 in right side bending (p = 0.03).
The variation in proportional motion between lumbar vertebrae during passive recumbent trunk motion was greater in patients with CNSLBP than in matched healthy controls, indicating that biomechanical factors in passive structures play a part.
从椎间移位中识别慢性非特异性下腰痛（CNSLBP）人群中的生物力学亚组一直难以实现。定量荧光透视（QF）具有出色的可重复性，并能从荧光透视序列中提供连续的标准化椎间运动学数据，从而允许对中程运动进行评估。本研究的目的是确定患者和对照组之间成比例的连续椎间旋转模式是否存在差异。第二个目的是更新QF测量椎间（IV）旋转运动范围（RoM）的可重复性。
记录了被动、卧位冠状面和矢状面运动的荧光透视序列，并对运动范围和速度进行了控制。比较了40例初级保健CNSLBP患者和40例匹配对照组的L2-5节段。患者还完成了von Korff慢性疼痛分级以及罗兰和莫里斯残疾问卷。使用自动图像跟踪算法对序列进行处理，以提取连续的椎间旋转数据。这些数据被转换为连续的成比例旋转范围（PR）。计算每个方向的连续成比例范围方差，并将其合并以产生一个表示其波动的单一变量（CPRV）。还计算了在受控躯干运动期间获得的最大IV-RoM测量值的评分者间和评分者内可重复性，以提供QF测量脊柱运动学的可靠性和一致性的更新指标。
患者的CPRV显著更高（0.011对0.008，曼-惠特尼双侧p = 0.008），这意味着存在一个机械亚组。受试者工作特征曲线分析发现其敏感性和特异性分别为0.78%（60-90）和0.55%（37-73）（曲线下面积为0.672）。CPRV与疼痛严重程度或残疾无关。最大椎间范围的可重复性极佳，但仅在L4-5节段右侧弯曲时患者的范围显著更大（p = 0.03）。
CNSLBP患者在被动卧位躯干运动期间腰椎之间的成比例运动变化比匹配的健康对照组更大，这表明被动结构中的生物力学因素起了作用。
