Centre for Biomechanics Research, AECC University College, Parkwood Campus, Bournemouth, BH5 2DF, UK.
Faculty of Science and Technology, Bournemouth University, Poole, BH12 5BB, UK.
Eur Spine J. 2018 Nov;27(11):2831-2839. doi: 10.1007/s00586-018-5666-1. Epub 2018 Jun 20.
Intervertebral kinematic assessments have been used to investigate mechanical causes when back pain is resistant to treatment, and recent studies have identified intervertebral motion markers that discriminate patients from controls. However, such patients are a heterogeneous group, some of whom have structural disruption, but the effects of this on intervertebral kinematics are unknown.
Thirty-seven patients with treatment-resistant back pain referred for quantitative fluoroscopy were matched to an equal number of pain-free controls for age and sex. All received passive recumbent flexion assessments for intervertebral motion sharing inequality (MSI), variability (MSV), laxity and translation. Comparisons were made between patient subgroups, between patients and controls and against normative levels from a separate group of controls.
Eleven patients had had surgical or interventional procedures, and ten had spondylolisthesis or pars defects. Sixteen had no disruption. Patients had significantly higher median MSI values (0.30) than controls (0.27, p = 0.010), but not MSV (patients 0.08 vs controls 0.08, p = 0.791). Patients who received invasive procedures had higher median MSI values (0.37) than those with bony defects (0.30, p = 0.018) or no disruption (0.28, p = 0.0007). Laxity and translation above reference limits were not more prevalent in patients.
Patients with treatment-resistant nonspecific back pain have greater MSI values than controls, especially if the former have received spinal surgery. However, excessive laxity, translation and MSV are not more prevalent in these patients. Thus, MSI should be investigated as a pain mechanism and for its possible value as a prognostic factor and/or target for treatment in larger patient populations. These slides can be retrieved under Electronic Supplementary Material.
当背痛治疗无效时，人们已经使用椎骨运动学评估来研究其力学原因，最近的研究已经确定了区分患者和对照组的椎骨运动标志物。然而，这些患者是一个异质群体，其中一些人存在结构破坏，但这种破坏对椎骨运动学的影响尚不清楚。
37 名治疗无效的背痛患者和年龄、性别匹配的 37 名无痛对照组患者接受了被动卧位下的屈伸评估，以评估椎骨运动的共享不匀性（MSI）、变异性（MSV）、松弛度和移位。比较了患者亚组之间、患者与对照组之间以及与另一组对照组的正常值之间的差异。
11 名患者接受了手术或介入治疗，10 名患者存在脊椎滑脱或椎板缺损。16 名患者无结构破坏。与对照组相比，患者的 MSI 中位数（0.30）显著更高（0.27，p=0.010），但 MSV 中位数无显著差异（患者 0.08 比对照组 0.08，p=0.791）。接受介入治疗的患者的 MSI 中位数（0.37）显著高于存在骨缺损的患者（0.30，p=0.018）或无结构破坏的患者（0.28，p=0.0007）。参考值以上的松弛度和移位在患者中并不更常见。
治疗无效的非特异性背痛患者的 MSI 值高于对照组，尤其是前者接受过脊柱手术的患者。然而，这些患者的过度松弛度、移位和 MSV 并不更常见。因此，MSI 应作为一种疼痛机制进行研究，并在更大的患者群体中研究其作为预后因素和/或治疗靶点的可能价值。这些幻灯片可在电子补充材料中检索。
