Okawa A, Shinomiya K, Komori H, Muneta T, Arai Y, Nakai O
Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Japan.
Spine (Phila Pa 1976). 1998 Aug 15;23(16):1743-9. doi: 10.1097/00007632-199808150-00007.
Dynamic lumbar flexion-extension motion was assessed by videofluoroscopy.
To identify the motion patterns of the whole lumbar spine in normal subjects and in patients with low back pain or spondylolisthesis during actual movement.
Assessment of lumbar instability on terminal radiographs is controversial. Information regarding spinal kinematics during actual movement in vivo is scarce.
Fluoroscopic lumbar sagittal motion videos were recorded in volunteers (n = 13; mean age, 22.3) and in patients with chronic low back pain (n = 8; mean age, 43.5) and degenerative spondylolisthesis (n = 8; mean age, 63.1) while the subjects bent forward from a standing neutral position (eccentric motion) and then returned to the original position (concentric motion). The videos recorded approximately 8 seconds of motion and were converted to still images at 5 frames per second. Disc angles from the horizontal line were measured to estimate sagittal rotation of each segment. Disc degeneration was evaluated on T2-weighted midsagittal magnetic resonance image.
In the volunteer group, six exhibited sequentially spreading motion, four exhibited simultaneous motion, and three showed an altered motion-spreading pattern in the eccentric phase. The first two patterns were considered normal. Six (67%) of the patients with chronic low back pain also showed normal patterns, but seven (88%) of the patients with degenerative spondylolisthesis showed disordered patterns. The order of motion in the concentric phase was also different among the three groups. Prolonged deflection of the slipped segment was observed more frequently in the patients with degenerative spondylolisthesis. Disc degeneration was not always associated with motion-spreading order and the motion patterns.
Segmental instability influences the whole lumbar motion in patients with degenerative spondylolisthesis. The patients with chronic low back pain did not show a significant difference when compared with the volunteers.
通过电视荧光透视法评估腰椎的动态屈伸运动。
确定正常受试者以及患有腰痛或腰椎滑脱症的患者在实际运动过程中整个腰椎的运动模式。
通过终末X线片评估腰椎不稳存在争议。关于体内实际运动过程中脊柱运动学的信息较少。
在志愿者（n = 13；平均年龄22.3岁）、慢性腰痛患者（n = 8；平均年龄43.5岁）和退行性腰椎滑脱症患者（n = 8；平均年龄63.1岁）从站立中立位向前弯腰（离心运动）然后回到初始位置（向心运动）时，记录荧光透视下腰椎矢状面运动视频。视频记录了约8秒的运动，并以每秒5帧的速度转换为静态图像。测量椎间盘与水平线的夹角以估计每个节段的矢状面旋转。在T2加权矢状面磁共振图像上评估椎间盘退变情况。
在志愿者组中，6人表现为依次传播运动，4人表现为同步运动，3人在离心阶段表现出改变的运动传播模式。前两种模式被认为是正常的。6名（67%）慢性腰痛患者也表现出正常模式，但7名（88%）退行性腰椎滑脱症患者表现出紊乱模式。三组在向心阶段的运动顺序也不同。在退行性腰椎滑脱症患者中更频繁地观察到滑脱节段的延长性偏斜。椎间盘退变并不总是与运动传播顺序和运动模式相关。
节段性不稳影响退行性腰椎滑脱症患者的整个腰椎运动。与志愿者相比，慢性腰痛患者未显示出显著差异。
