Krismer M, Haid C, Ogon M, Behensky H, Wimmer C
Universitätsklinik für Orthopädie, Innsbruck.
Orthopade. 1997 Jun;26(6):516-20. doi: 10.1007/PL00003406.
Several authors have tried to define segmental lumbar instability. Their definitions: increased antero-posterior translation, pathologic coupled motion, increased neutral zone, pathologic instantaneous center of rotation describe some mechanic findings occurring in the aging spine. However, there is no evidence that they help to differentiate the pathologic entity of segmental lumbar instability from the normal aging process. Dynamic explanation models are promising but at the moment they cannot be used clinically for diagnosis of instability as well. The most important structure to maintain lumbar stability is the intervertebral disc. In the third and fourth decade, more than 50 percent of specimen show peripheral tears of the anulus. It was shown in animal experiments that these tears develop to radial tears, which are accompanied by nuclear volume loss and decreased height. The facets degenerate one or two decades later. Corresponding with the loss of discal function, they increasingly contribute to spinal stability. In conclusion, the concept of lumbar segmental instability is not very helpful in clinical practise. It is recommended to base the decision of lumbar fusion on a painful degenerated disc, and additional findings promising a good result.
几位作者试图定义节段性腰椎不稳。他们的定义包括：前后移位增加、病理性耦合运动、中性区增加、病理性瞬时旋转中心，这些描述了在衰老脊柱中出现的一些力学表现。然而，没有证据表明它们有助于将节段性腰椎不稳的病理实体与正常衰老过程区分开来。动态解释模型很有前景，但目前它们也不能用于临床诊断不稳。维持腰椎稳定性最重要的结构是椎间盘。在三十和四十岁时，超过50%的标本显示纤维环周边撕裂。动物实验表明，这些撕裂会发展为放射状撕裂，并伴有髓核体积减小和高度降低。小关节在一二十年后退变。与椎间盘功能丧失相对应，它们对脊柱稳定性的贡献越来越大。总之，腰椎节段性不稳的概念在临床实践中帮助不大。建议基于疼痛性退变椎间盘以及其他有望取得良好效果的发现来决定是否进行腰椎融合术。
