Department of Physical Medicine & Rehabilitation, The University of Kansas Medical Center, Kansas City, KS 66160, United States.
Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS 66160, United States.
Pain Med. 2023 Dec 1;24(12):1341-1354. doi: 10.1093/pm/pnad098.
Chronic low back pain (CLBP) is multifactorial in nature, with recent research highlighting the role of multifidus dysfunction in a subset of nonspecific CLBP. This review aimed to provide a foundational reference that elucidates the pathophysiological cascade of multifidus dysfunction, how it contrasts with other CLBP etiologies and the role of restorative neurostimulation.
A scoping review of the literature.
In total, 194 articles were included, and findings were presented to highlight emerging principles related to multifidus dysfunction and restorative neurostimulation. Multifidus dysfunction is diagnosed by a history of mechanical, axial, nociceptive CLBP and exam demonstrating functional lumbar instability, which differs from other structural etiologies. Diagnostic images may be used to grade multifidus atrophy and assess other structural pathologies. While various treatments exist for CLBP, restorative neurostimulation distinguishes itself from traditional neurostimulation in a way that treats a different etiology, targets a different anatomical site, and has a distinctive mechanism of action.
Multifidus dysfunction has been proposed to result from loss of neuromuscular control, which may manifest clinically as muscle inhibition resulting in altered movement patterns. Over time, this cycle may result in potential atrophy, degeneration and CLBP. Restorative neurostimulation, a novel implantable neurostimulator system, stimulates the efferent lumbar medial branch nerve to elicit repetitive multifidus contractions. This intervention aims to interrupt the cycle of dysfunction and normalize multifidus activity incrementally, potentially restoring neuromuscular control. Restorative neurostimulation has been shown to reduce pain and disability in CLBP, improve quality of life and reduce health care expenditures.
慢性下腰痛（CLBP）本质上是多因素的，最近的研究强调了多裂肌功能障碍在特定非特异性 CLBP 患者中的作用。本综述旨在提供一个基础性参考，阐明多裂肌功能障碍的病理生理级联反应、它与其他 CLBP 病因的区别以及修复性神经刺激的作用。
对文献进行范围界定综述。
共纳入 194 篇文章，结果表明，新兴的多裂肌功能障碍和修复性神经刺激相关原则正在出现。多裂肌功能障碍通过机械、轴向、疼痛性 CLBP 的病史以及表现出功能腰椎不稳定的检查来诊断，这与其他结构病因不同。诊断图像可用于分级多裂肌萎缩和评估其他结构病理学。虽然 CLBP 存在各种治疗方法，但修复性神经刺激与传统神经刺激不同，它治疗不同的病因，针对不同的解剖部位，具有独特的作用机制。
多裂肌功能障碍被认为是由于失去神经肌肉控制引起的，这可能在临床上表现为肌肉抑制，导致运动模式改变。随着时间的推移，这种循环可能导致潜在的萎缩、变性和 CLBP。修复性神经刺激是一种新型植入式神经刺激系统，刺激传出的腰椎内侧支神经，引起重复的多裂肌收缩。这种干预旨在中断功能障碍循环，逐步恢复神经肌肉控制。修复性神经刺激已被证明可减轻 CLBP 的疼痛和残疾，改善生活质量并降低医疗保健支出。
