MSK LAB, Imperial College London, London, United Kingdom; School of Health Sciences, The University of Manchester and University of Manchester NHS Foundation Trust, Manchester, United Kingdom.
MSK LAB, Imperial College London, London, United Kingdom; Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
Gait Posture. 2022 May;94:222-229. doi: 10.1016/j.gaitpost.2021.03.037. Epub 2021 Apr 2.
Lumbar Disc Degeneration (LDD) is associated with recurrent low back pain (LBP) (symptomatic). However, in some instances of LDD, people do not experience LBP (asymptomatic).
As a step towards understanding why some people with LDD experience LBP and others do not, the primary aim of this study was to examine differences in anticipatory (APA) and compensatory postural adjustments (CPA), between symptomatic LDD patients (LDD pain) and asymptomatic LDD controls (LDD no pain) during postural perturbation. The secondary aim was to determine simultaneous differences in mental health, disability and quality of life status.
3 T MRI was used to acquire T2 weighted images (L1-S1) from LDD no pain (n = 34) and LDD pain groups (n = 34). In this observational study, responses to predicted and unpredicted forward perturbations were examined using three dimensional motion capture. A Mann Whitney U test was conducted to examine group differences in sagittal spine and lower limb kinematics (integrated angular displacements during four established APA and CPA time intervals), anxiety, depression, disability and quality of life.
The LDD pain group exhibited lower hip and knee displacements (p = 0.049-0.040) than the LDD no pain group during predicted and unpredicted perturbation. The LDD pain group also exhibited higher compensatory lumbar displacement than the LDD no pain group (p = 0.040-0.005) in the predicted condition but there was no difference observed in the unpredicted condition. The LDD pain group experienced higher levels of depression, anxiety and disability (p < 0.0001) and lower quality of life (p = 0.0001) than LDD controls.
Symptomatic LDD patients are different from LDD controls; they exhibit different kinematic strategies, levels of disability, anxiety, depression and quality of life. Effective care may benefit from evaluating and targeting these differences.
腰椎间盘退变（LDD）与复发性腰痛（LBP）（有症状）有关。然而，在一些 LDD 病例中，人们没有经历腰痛（无症状）。
为了了解为什么一些患有 LDD 的人会出现腰痛，而另一些人则不会，本研究的主要目的是检查有症状的 LDD 患者（LDD 疼痛）和无症状的 LDD 对照组（LDD 无疼痛）在姿势扰动期间的预期性（APA）和代偿性姿势调整（CPA）的差异。次要目的是确定心理健康、残疾和生活质量状况的同时差异。
使用 3T MRI 从 LDD 无疼痛（n=34）和 LDD 疼痛组（n=34）获得 L1-S1 的 T2 加权图像。在这项观察性研究中，使用三维运动捕捉来检查对预测和未预测的前向扰动的反应。使用 Mann Whitney U 检验比较矢状脊柱和下肢运动学（四个既定 APA 和 CPA 时间间隔内的综合角度位移）、焦虑、抑郁、残疾和生活质量的组间差异。
与 LDD 无疼痛组相比，LDD 疼痛组在预测和未预测扰动期间的髋关节和膝关节位移较低（p=0.049-0.040）。在预测条件下，LDD 疼痛组的代偿性腰椎位移也高于 LDD 无疼痛组（p=0.040-0.005），但在未预测条件下没有观察到差异。LDD 疼痛组的抑郁、焦虑和残疾程度较高（p<0.0001），生活质量较低（p=0.0001），与 LDD 对照组相比。
有症状的 LDD 患者与 LDD 对照组不同；他们表现出不同的运动学策略、残疾程度、焦虑、抑郁和生活质量。有效的护理可能受益于评估和针对这些差异。
