Espinoza Orías Alejandro A, Mammoser Nicole M, Triano John J, An Howard S, Andersson Gunnar B J, Inoue Nozomu
Assistant Professor, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
Research Assistant, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
J Manipulative Physiol Ther. 2016 May;39(4):294-303. doi: 10.1016/j.jmpt.2016.03.002. Epub 2016 Apr 6.
Axial rotation of the torso is commonly used during manipulation treatment of low back pain. Little is known about the effect of these positions on disc morphology. Rotation is a three-dimensional event that is inadequately represented with planar images in the clinic. True quantification of the intervertebral gap can be achieved with a disc height distribution. The objective of this study was to analyze disc height distribution patterns during torsion relevant to manipulation in vivo.
Eighty-one volunteers were computed tomography-scanned both in supine and in right 50° rotation positions. Virtual models of each intervertebral gap representing the disc were created with the inferior endplate of each "disc" set as the reference surface and separated into 5 anatomical zones: 4 peripheral and 1 central, corresponding to the footprint of the annulus fibrosus and nucleus pulposus, respectively. Whole-disc and individual anatomical zone disc height distributions were calculated in both positions and were compared against each other with analysis of variance, with significance set at P < .05.
Mean neutral disc height was 7.32 mm (1.59 mm). With 50° rotation, a small but significant increase to 7.44 mm (1.52 mm) (P < .0002) was observed. The right side showed larger separation in most levels, except at L5/S1. The posterior and right zones increased in height upon axial rotation of the spine (P < .0001), whereas the left, anterior, and central decreased.
This study quantified important tensile/compressive changes disc height during torsion. The implications of these mutually opposing changes on spinal manipulation are still unknown.
在腰痛的手法治疗中，躯干的轴向旋转是常用的操作。关于这些体位对椎间盘形态的影响，人们知之甚少。旋转是一个三维事件，而临床中的平面图像无法充分体现这一点。通过椎间盘高度分布可实现对椎间间隙的真正量化。本研究的目的是分析与体内手法操作相关的扭转过程中椎间盘高度的分布模式。
81名志愿者分别在仰卧位和右侧旋转50°位进行了计算机断层扫描。以每个“椎间盘”的下终板为参考面，创建了代表椎间盘的每个椎间间隙的虚拟模型，并将其分为5个解剖区域：4个周边区域和1个中央区域，分别对应纤维环和髓核的足迹。计算两个体位下的全椎间盘和各个解剖区域的椎间盘高度分布，并通过方差分析相互比较，显著性设定为P < .05。
平均中立位椎间盘高度为7.32 mm（1.59 mm）。在50°旋转时，观察到有小幅但显著的增加，达到7.44 mm（1.52 mm）（P < .0002）。除L5/S1外，大多数节段右侧的间隙更大。脊柱轴向旋转时，后方和右侧区域的高度增加（P < .0001），而左侧、前方和中央区域的高度降低。
本研究量化了扭转过程中椎间盘高度重要的拉伸/压缩变化。这些相互对立的变化对脊柱手法治疗的影响仍不清楚。
