Suzuki Manabu, Tanaka Yasuhisa, Hashimoto Ko, Tsubakino Takumi, Hoshikawa Takeshi, Takahashi Kohei, Latt Myo Min, Aizawa Toshimi
Department of Orthopaedic Surgery, Tohoku Central Hospital, Yamagata 990-8510, Japan.
Department of Orthopaedic Surgery, National Hospital Organization Sendai Medical Center, Sendai 983-8520, Japan.
J Clin Med. 2024 Oct 14;13(20):6116. doi: 10.3390/jcm13206116.
: Low back pain is thought to be caused by lumbar instability. To date, multiple definitions of radiological lumbar instability have been used without verifying the "normal range" of the lumbar segmental mobility. Ideally, normative data for lumbar mobility in healthy individuals are required to establish an acceptable threshold for lumbar instability. This study aims to elucidate (i) the prevalence of so-called radiological lumbar instability at each lumbar spine level in conventional criteria and (ii) a practical radiological threshold for lumbar instability in healthy individuals. : Participants completed a questionnaire and underwent standard active dynamic radiography of the lumbar spine in the standing position. Intervertebral range of motion (IROM) and sagittal translation distance (ΔST) were measured at each intervertebral level. Nachemson's criteria of radiological lumbar instability were applied. : This study involved four hundred and twenty participants (249 males and 171 females); 76% (320/420) met the criteria for radiological lumbar instability. The definition of lumbar instability based on IROM and ΔST was achieved by 0.2% and 1.7% of participants at the L5-sacrum (L5-S) level, respectively. : The normative data of lumbar mobility were obtained from a large number of participants who had less LBP-related ADL disability. The widely accepted criteria for lumbar instability were not applicable except for the L5-S level. Further studies of lumbar mobility, including patients with severe LBP, might prove the relationship between hypermobility of the lumbar spine and LBP.
下腰痛被认为是由腰椎不稳定引起的。迄今为止，已经使用了多种放射学腰椎不稳定的定义，但并未验证腰椎节段活动度的“正常范围”。理想情况下，需要健康个体腰椎活动度的规范数据来确定腰椎不稳定的可接受阈值。本研究旨在阐明：（i）按照传统标准，每个腰椎节段所谓放射学腰椎不稳定的患病率；（ii）健康个体腰椎不稳定的实际放射学阈值。研究参与者完成了一份问卷，并在站立位接受了腰椎的标准主动动态放射成像。测量了每个椎间水平的椎间活动度（IROM）和矢状面平移距离（ΔST）。应用了纳赫姆森放射学腰椎不稳定标准。本研究纳入了420名参与者（249名男性和171名女性）；76%（320/420）符合放射学腰椎不稳定标准。基于IROM和ΔST的腰椎不稳定定义分别在L5-骶骨（L5-S）水平由0.2%和1.7%的参与者达到。腰椎活动度的规范数据来自大量与下腰痛相关的日常生活活动残疾程度较低的参与者。除了L5-S水平外，广泛接受的腰椎不稳定标准并不适用。对包括严重下腰痛患者在内的腰椎活动度的进一步研究可能会证实腰椎过度活动与下腰痛之间的关系。
