Chou Shih-Hsiang, Lin Sung-Yen, Shen Po-Chih, Tu Hung-Pin, Huang Hsuan-Ti, Shih Chia-Lung, Lu Cheng-Chang
Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
Orthopaedic Research Centre, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
J Clin Med. 2021 Sep 2;10(17):3984. doi: 10.3390/jcm10173984.
Diagnosing intervertebral instability is crucial for the treatment of degenerative lumbar spondylolisthesis (DLS). Disabling back pain will reduce spinal mobility which leads to an underestimate of the incidence of intervertebral instability. We hypothesized that adequate analgesia could alter the flexion/extension exam performance, and thus increase the diagnostic accuracy of segmental instability.
One hundred patients with low-grade DLS were prospectively enrolled in the before-after cohort study. Standing lateral flexion/extension radiographs of lumbar spines were examined and analyzed before and after intramuscular injections of 30 mg ketorolac.
Pain score decreased significantly after analgesic injections ( < 0.001). Dynamic slip (DS), dynamic segmental angle (DA), dynamic lumbar lordosis, and slip percentage (SP) were significantly increased after pain reduction (all < 0.001). According to the diagnostic criteria for segmental instability (DS > 4.5 mm, DA > 15°, or SP > 15%), there were 4%, 4%, and 0.7% of total motion segments fulfilling the criteria which markedly increased to 42%, 32%, and 16.7% after analgesia was administered. The incidence of instability also increased from 6% to 38% after analgesia.
The diagnosis rate of intervertebral instability is commonly underestimated in the presence of low back pain. This short-term pain relief facilitates reliable functional imaging adding to the diagnosis of intervertebral instability.
诊断椎间不稳对于退行性腰椎滑脱（DLS）的治疗至关重要。致残性背痛会降低脊柱活动度，从而导致对椎间不稳发生率的低估。我们假设充分的镇痛可以改变屈伸检查的表现，进而提高节段性不稳的诊断准确性。
100例轻度DLS患者前瞻性纳入前后队列研究。在肌肉注射30mg酮咯酸前后，对腰椎站立位侧位屈伸X线片进行检查和分析。
镇痛注射后疼痛评分显著降低（<0.001）。疼痛减轻后，动态滑移（DS）、动态节段角（DA）、动态腰椎前凸和滑移百分比（SP）均显著增加（均<0.001）。根据节段性不稳的诊断标准（DS>4.5mm，DA>15°，或SP>15%），满足标准的总运动节段分别为4%、4%和0.7%，镇痛后显著增加至42%、32%和16.7%。镇痛后不稳发生率也从6%增加到38%。
在存在腰痛的情况下，椎间不稳的诊断率通常被低估。这种短期的疼痛缓解有助于进行可靠的功能成像，辅助椎间不稳的诊断。
