Sabnis Ashutosh B, Chamoli Uphar, Diwan Ashish D
Spine Service, Department of Orthopaedic Surgery, St. George & Sutherland Clinical School, University of New South Wales, Kogarah, Sydney, NSW, 2217, Australia.
Eur Spine J. 2018 May;27(5):1127-1135. doi: 10.1007/s00586-017-5400-4. Epub 2017 Nov 27.
The relationship between biomechanical instability and degenerative changes in the lumbar spine in chronic low back pain (CLBP) patients remains controversial. The main objective of this retrospective radiographical study was to evaluate changes in kinematics at different lumbar levels (in particular the L5-S1 level) with progressive grades of disc degeneration and facet joint osteoarthritis in CLBP patients.
Using standing neutral and dynamic flexion/extension (Fx/Ex) radiographs of the lumbar spine, in vivo segmental kinematics at L1-L2 through L5-S1 were evaluated in 72 consecutive CLBP patients. Disc degeneration was quantified using changes in signal intensity and central disc height on mid-sagittal T2-weighted magnetic resonance (MR) scans. Additionally, the presence or absence of facet joint osteoarthritis was noted on T2-weighted axial MR scans.
Disc degeneration and facet joint osteoarthritis occurred independent of each other at the L5-S1 level (p = 0.188), but an association was observed between the two at L4-L5 (p < 0.001) and L3-L4 (p < 0.05) levels. In the absence of facet joint osteoarthritis, the L5-S1 segment showed a greater range of motion (ROM) in Ex (3.3° ± 3.6°) and a smaller ROM in Fx (0.6° ± 4.2°) compared with the upper lumbar levels (p < 0.05), but the differences diminished in the presence of it. In the absence of facet joint osteoarthritis, no change in L5-S1 kinematics was observed with progressive disc degeneration, but in its presence, restabilisation of the L5-S1 segment was observed between mild and severe disc degeneration states.
The L5-S1 motion segment exhibited unique degenerative and kinematic characteristics compared with the upper lumbar motion segments. Disc degeneration and facet joint osteoarthritis occurred independent of each other at the L5-S1 level, but not at the other lumbar levels. Severe disc degeneration in the presence of facet joint osteoarthritis biomechanically restabilised the L5-S1 motion segment.
慢性下腰痛（CLBP）患者腰椎的生物力学不稳定与退变改变之间的关系仍存在争议。这项回顾性影像学研究的主要目的是评估CLBP患者不同腰椎节段（尤其是L5-S1节段）在椎间盘退变和小关节骨关节炎进展分级情况下的运动学变化。
使用腰椎站立位中立位及动态屈伸（Fx/Ex）X线片，对72例连续的CLBP患者的L1-L2至L5-S1节段进行体内节段运动学评估。通过矢状面T2加权磁共振（MR）扫描上信号强度和椎间盘中央高度的变化对椎间盘退变进行量化。此外，在T2加权轴位MR扫描上记录小关节骨关节炎的有无。
在L5-S1节段，椎间盘退变和小关节骨关节炎相互独立发生（p = 0.188），但在L4-L5（p < 0.001）和L3-L4（p < 0.05）节段观察到两者之间存在关联。在没有小关节骨关节炎的情况下，与上位腰椎节段相比，L5-S1节段在伸展（Ex）时显示出更大的活动范围（ROM）（3.3°±3.6°），在屈曲（Fx）时显示出更小的ROM（0.6°±4.2°）（p < 0.05），但在存在小关节骨关节炎时差异减小。在没有小关节骨关节炎的情况下，随着椎间盘退变的进展，未观察到L5-S1节段运动学的变化，但在存在小关节骨关节炎时，在轻度和重度椎间盘退变状态之间观察到L5-S1节段的重新稳定。
与上位腰椎运动节段相比，L5-S1运动节段表现出独特的退变和运动学特征。在L5-S1节段，椎间盘退变和小关节骨关节炎相互独立发生，但在其他腰椎节段并非如此。在存在小关节骨关节炎的情况下，严重的椎间盘退变在生物力学上使L5-S1运动节段重新稳定。
