Dennis Hey Hwee Weng, Choong Denise Ai Wen, Lin Adrian Zhigao, Lau Eugene Tze-Chun, Teo Alex Quok An, Liu Gabriel, Wong Hee-Kit
University Orthopaedics, Hand and Reconstructive Microsurgery Cluster (UOHC), National University Health System, Singapore, Singapore.
J Spine Surg. 2018 Dec;4(4):750-756. doi: 10.21037/jss.2018.09.07.
A comparative survey from patients and radiographers of the new slump sitting flexion posture and the conventional standing forward bending posture. This study was performed to compare the technical and logistical aspects of the slump sitting versus the forward bending posture. Slump sitting flexes the lumbar spine more than the forward bending and increases the diagnosis rate of sagittal spinal instability up to 40% depending on the diagnostic criteria used. This should not come at the expense of patient safety and comfort nor burden the radiographers.
Sixty patients were recruited from a single tertiary spine centre. Patients were block randomised into two groups with either the forward bending or the slump sitting being performed first. Feedback was obtained through self-administered questionnaires from patients regarding perceived safety, convenience and comfort, plus from radiographers regarding the imaging process, proxy measures of radiographer ability and scan difficulty.
There was no significant difference between the baseline characteristics in both groups. Majority (63%) of patients preferred slump sitting and felt that forward bending caused pain (P=0.025). Overall, slump sitting was equivalent in comfort, perceived safety and ease to forward bending. Despite requiring more logistics (P=0.031), more effort to set up (P=0.002) and explain (P=0.012), the majority of radiographers (83%) preferred slump sitting. This method was felt to be less dangerous (P=0.015) and easier to maintain (P<0.001).
This study showed that the superiority of slump sitting in allowing more lumbar flexion compared to the forward bending comes with patient safety or comfort. The technical demands of the learning curve can be offset with training. As such, slump sitting flexion views should be adopted as the standardized method for assessing spinal instability.
对新的 slumped 坐姿屈曲姿势与传统站立前屈姿势进行患者和放射技师的比较调查。本研究旨在比较 slumped 坐姿与前屈姿势在技术和后勤方面的差异。与前屈相比，slumped 坐姿能使腰椎更屈曲，根据所使用的诊断标准，矢状位脊柱不稳的诊断率可提高至40%。但这不应以牺牲患者安全和舒适度为代价，也不应给放射技师带来负担。
从一个单一的三级脊柱中心招募了60名患者。患者被整群随机分为两组，分别先进行前屈或 slumped 坐姿。通过患者自行填写的问卷获得关于感知到的安全性、便利性和舒适度的反馈，以及放射技师关于成像过程、放射技师能力的替代指标和扫描难度的反馈。
两组的基线特征无显著差异。大多数（63%）患者更喜欢 slumped 坐姿，并感觉前屈会引起疼痛（P = 0.025）。总体而言，slumped 坐姿在舒适度、感知安全性和与前屈的易操作性方面相当。尽管需要更多后勤工作（P = 0.031）、更多的设置精力（P = 0.002）和解释精力（P = 0.012），但大多数放射技师（83%）更喜欢 slumped 坐姿。这种方法被认为危险性更小（P = 0.015）且更容易保持（P < 0.001）。
本研究表明，与前屈相比，slumped 坐姿在允许更多腰椎屈曲方面具有优势，且不影响患者安全或舒适度。学习曲线的技术要求可以通过培训来抵消。因此，slumped 坐姿屈曲视图应被采用为评估脊柱不稳的标准化方法。
