腰椎的运动学和脊椎病会因下背痛患者个体中运动节段的水平不同而有所差异。
The Kinematics and Spondylosis of the Lumbar Spine Vary Depending on the Levels of Motion Segments in Individuals With Low Back Pain.
作者信息
Basques Bryce A, Espinoza Orías Alejandro A, Shifflett Grant D, Fice Michael P, Andersson Gunnar B, An Howard S, Inoue Nozomu
机构信息
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
出版信息
Spine (Phila Pa 1976). 2017 Jul 1;42(13):E767-E774. doi: 10.1097/BRS.0000000000001967.
STUDY DESIGN
A prospective cohort study.
OBJECTIVE
The aim of this study was to identify associations of spondylotic and kinematic changes with low back pain (LBP).
SUMMARY OF BACKGROUND DATA
The ability to characterize and differentiate the biomechanics of both the symptomatic and asymptomatic lumbar spine is crucial to alleviate the sparse literature on the association of lumbar spine biomechanics and LBP.
METHODS
Lumbar dynamic plain radiographs (flexion-extension), dynamic computed tomography (CT) scanning (axial rotation, disc height), and magnetic resonance imaging (MRI, disc and facet degeneration grades) were obtained for each subject. These parameters were compared between symptomatic and control groups using Student t test and multivariate logistic regression, which controlled for patient age and sex and identified spinal parameters that were independently associated with symptomatic LBP. Disc grade and mean segmental motion by level were tested by one-way analysis of variance (ANOVA).
RESULTS
Ninety-nine volunteers (64 asymptomatic/35 LBP) were prospectively recruited. Mean age was 37.3 ± 10.1 years and 55% were male. LBP showed association with increased L5/S1 translation [odds ratio (OR) 1.63 per mm, P = 0.005], decreased flexion-extension motion at L1/L2 (OR 0.87 per degree, P = 0.036), L2/L3 (OR 0.88 per degree, P = 0.036), and L4/L5 (OR 0.87 per degree, P = 0.020), increased axial rotation at L4/L5 (OR 2.11 per degree, P = 0.032), decreased disc height at L3/L4 (OR 0.52 per mm, P = 0.008) and L4/L5 (OR 0.37 per mm, p < 0.001), increased disc grade at all levels (ORs 2.01-12.33 per grade, P = 0.001-0.026), and increased facet grade at L4/L5 (OR 4.99 per grade, P = 0.001) and L5/S1 (OR 3.52 per grade, P = 0.004). Significant associations were found between disc grade and kinematic parameters (flexion-extension motion, axial rotation, and translation) at L4/L5 (P = 0.001) and L5/S1 (P < 0.001), but not at other levels (P > 0.05).
CONCLUSION
In symptomatic individuals, L4/L5 and L5/S1 levels were affected by spondylosis and kinematic changes. This study clarifies the relationships between kinematic alterations and LBP, mostly observed at the above-mentioned segments.
LEVEL OF EVIDENCE
N/A.
研究设计
一项前瞻性队列研究。
目的
本研究旨在确定脊柱退变和运动学变化与腰痛（LBP）之间的关联。
背景数据总结
表征和区分有症状和无症状腰椎的生物力学的能力对于缓解关于腰椎生物力学与LBP关联的文献稀少的情况至关重要。
方法
为每位受试者获取腰椎动态X线平片（屈伸位）、动态计算机断层扫描（CT）（轴向旋转、椎间盘高度）和磁共振成像（MRI，椎间盘和小关节退变分级）。使用学生t检验和多因素逻辑回归对有症状组和对照组之间的这些参数进行比较，多因素逻辑回归对患者年龄和性别进行了控制，并确定了与有症状LBP独立相关的脊柱参数。通过单因素方差分析（ANOVA）对椎间盘分级和各节段的平均节段运动进行检验。
结果
前瞻性招募了99名志愿者（64名无症状/35名LBP患者）。平均年龄为37.3±10.1岁，55%为男性。LBP与L5/S1节段平移增加相关[比值比（OR）为每毫米1.63，P = 0.005]，L1/L2（OR为每度0.87，P = 0.036）、L2/L3（OR为每度0.88，P = 0.036）和L4/L5（OR为每度0.87，P = 0.020）节段屈伸运动减少相关，L4/L5节段轴向旋转增加（OR为每度2.11，P = 0.032），L3/L4（OR为每毫米0.52，P = 0.008）和L4/L5（OR为每毫米0.37，P < 0.001）节段椎间盘高度降低相关，所有节段椎间盘分级增加（OR为每级2.01 - 12.33，P = 0.001 - 0.026），L4/L5（OR为每级4.99，P = 0.001）和L5/S1（OR为每级3.52，P = 0.004）节段小关节分级增加。在L4/L5（P = 0.001）和L5/S1（P < 0.001）节段，椎间盘分级与运动学参数（屈伸运动、轴向旋转和平移）之间存在显著关联，但在其他节段无显著关联（P > 0.05）。
结论
在有症状的个体中，L4/L5和L5/S1节段受到脊柱退变和运动学变化的影响。本研究阐明了运动学改变与LBP之间的关系，主要在上述节段观察到这种关系。
证据水平
无。
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