推进脊柱疼痛患者的影像学技术：重点关注挥鞭样损伤。
Advancing imaging technologies for patients with spinal pain: with a focus on whiplash injury.
机构信息
Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 N. Michigan Ave, Suite 1100, Chicago, IL, USA; School of Health and Rehabilitation Sciences, The University of Queensland, Australia; Zürich University of Applied Sciences, Gertrudstrasse 15, 8401 Winterthur, Switzerland.
Faculty of Medicine and Health Sciences, Macquarie University, 2 Technology Pl, Macquarie Park, Sydney, NSW 2113, Australia.
出版信息
Spine J. 2018 Aug;18(8):1489-1497. doi: 10.1016/j.spinee.2017.06.015. Epub 2017 Jul 31.
BACKGROUND CONTEXT
Radiological observations of soft-tissue changes that may relate to clinical symptoms in patients with traumatic and non-traumatic spinal disorders are highly controversial. Studies are often of poor quality and findings are inconsistent. A plethora of evidence suggests some pathoanatomical findings from traditional imaging applications are common in asymptomatic participants across the life span, which further questions the diagnostic, prognostic, and theranostic value of traditional imaging. Although we do not dispute the limited evidence for the clinical importance of most imaging findings, we contend that the disparate findings across studies may in part be due to limitations in the approaches used in assessment and analysis of imaging findings.
PURPOSE
This clinical commentary aimed to (1) briefly detail available imaging guidelines, (2) detail research-based evidence around the clinical use of findings from advanced, but available, imaging applications (eg, fat and water magnetic resonance imaging and magnetization transfer imaging), and (3) introduce how evolving imaging technologies may improve our mechanistic understanding of pain and disability, leading to improved treatments and outcomes.
STUDY DESIGN/SETTING: A non-systematic review of the literature is carried out.
METHODS
A narrative summary (including studies from the authors' own work in whiplash injuries) of the available literature is provided.
RESULTS
An emerging body of evidence suggests that the combination of existing imaging sequences or the use of developing imaging technologies in tandem with a good clinical assessment of modifiable risk factors may provide important diagnostic information toward the exploration and development of more informed and effective treatment options for some patients with traumatic neck pain.
CONCLUSIONS
Advancing imaging technologies may help to explain the seemingly disconnected spectrum of biopsychosocial signs and symptoms of traumatic neck pain.
背景
在创伤性和非创伤性脊柱疾病患者中，放射学观察到的可能与临床症状相关的软组织变化极具争议。这些研究往往质量较差，结果也不一致。大量证据表明，在整个生命周期中，无症状参与者中传统影像学应用的一些病理解剖学发现很常见，这进一步质疑了传统影像学的诊断、预后和治疗价值。尽管我们不否认大多数影像学发现对临床的重要性的有限证据，但我们认为，研究之间的差异可能部分是由于评估和分析影像学发现的方法存在局限性。
目的
本临床述评旨在：（1）简要详细介绍现有的影像学指南；（2）详细介绍先进但可用的影像学应用（例如脂肪和水磁共振成像和磁化传递成像）中发现的临床应用的研究证据；（3）介绍不断发展的成像技术如何改善我们对疼痛和残疾的机制理解，从而改善治疗效果和结果。
研究设计/设置：对文献进行非系统性综述。
方法
对现有文献进行叙述性总结（包括作者自己在挥鞭伤中的研究）。
结果
越来越多的证据表明，现有的成像序列的组合或在良好的临床评估可改变的危险因素的基础上使用新兴的成像技术，可能为一些创伤性颈部疼痛患者的探索和开发更明智和有效的治疗方案提供重要的诊断信息。
结论
先进的成像技术可以帮助解释创伤性颈部疼痛的生物心理社会症状的看似不相关的谱。
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