Solomonow M, Zhou B H, Harris M, Lu Y, Baratta R V
Department of Orthopaedic Surgery, Louisiana State University Medical Center, New Orleans.
Spine (Phila Pa 1976). 1998 Dec 1;23(23):2552-62. doi: 10.1097/00007632-199812010-00010.
Electrical and mechanical stimulation of the lumbar supraspinous ligament of three patients with L4-L5 spinal deficits and of the feline model, respectively, was applied while recording electromyography on the multifidus muscles.
To determine if mechanoreceptors in the human spine can reflexively recruit muscle force to stabilize the lumbar spine, and to demonstrate, in the feline model, that such ligamento-muscular synergy is elicited by mechanical deformation of the lumbar supraspinous ligament (and possibly of other spinal ligaments), the facet joint capsule, and the disc.
The literature repeatedly confirms that ligaments have only a minor mechanical role in maintaining spine stability, and that muscular co-contraction of anterior and posterior muscles is the major stabilizing mechanism of the spine. The literature also points out that various sensory receptors are present in spinal ligaments, and that the ligaments are innervated by spinal and autonomic nerves. Data that describe how ligaments and muscles interact to provide stability to the spine were not found.
The supraspinous ligament at L2-L3 and L3-L4 was electrically stimulated in three patients undergoing surgery to correct deficits at L4-L5. Electromyography was performed from the multifidus muscles at L2-L3 and L3-L4, bilaterally. In 12 cats, the supraspinous ligaments from L1-L2 to L6-L7 were mechanically deformed, sequentially, while electromyography was performed from the multifidus muscles of the six levels. Loading of the ligament was applied before and after each of the two vertebrae were externally fixed to prevent motion.
Electromyograms were recorded from the multifidus muscles, bilaterally, in the two of the three patients, demonstrating a direct relationship to receptors in the supraspinous ligament. Electromyograms were recorded from the feline multifidus muscle with mechanical loading of the supraspinal ligament at each of the L1-L2 to L6-L7 motion segments. In the free-spine condition the largest electromyographic discharge was present in the level of ligament deformation, and lower electromyographic discharge was recorded in two rostral and caudal segments. After immobilizing any two vertebrae, loading of the ligament resulted in electromyographic discharge in the muscles of the same level and at least one level above and/or below.
Deformation or stress in the supraspinous ligament, and possibly in other spinal ligaments, recruits multifidus muscle force to stiffen one to three lumbar motion segments and prevent instability. Strong muscular activity is seen when loads that can cause permanent damage to the ligament are applied, indicating that spastic muscle activity and possibly pain can be caused by ligament overloading.
分别对3例L4-L5脊柱功能缺损患者的腰棘上韧带以及猫模型的腰棘上韧带进行电刺激和机械刺激，同时记录多裂肌的肌电图。
确定人类脊柱中的机械感受器是否能通过反射募集肌肉力量以稳定腰椎，并在猫模型中证明腰椎棘上韧带（可能还有其他脊柱韧带）、小关节囊和椎间盘的机械变形可引发这种韧带-肌肉协同作用。
文献反复证实韧带在维持脊柱稳定性方面仅起次要的机械作用，前后肌肉的共同收缩是脊柱的主要稳定机制。文献还指出脊柱韧带中存在各种感觉感受器，且韧带由脊神经和自主神经支配。未找到描述韧带与肌肉如何相互作用以提供脊柱稳定性的数据。
对3例接受手术矫正L4-L5功能缺损的患者，在L2-L3和L3-L4水平对棘上韧带进行电刺激。双侧记录L2-L3和L3-L4水平多裂肌的肌电图。在12只猫中，依次对L1-L2至L6-L7的棘上韧带进行机械变形，同时记录六个水平多裂肌的肌电图。在对相邻两个椎体进行外部固定以防止运动前后分别对韧带施加负荷。
3例患者中有2例双侧多裂肌记录到肌电图，显示与棘上韧带中的感受器有直接关系。在L1-L2至L6-L7每个运动节段对猫的棘上韧带进行机械加载时，均记录到多裂肌的肌电图。在脊柱自由状态下，韧带变形水平出现最大肌电发放，在头侧和尾侧两个节段记录到较低的肌电发放。固定任意两个椎体后，韧带加载导致相同水平以及至少一个相邻上/下水平肌肉出现肌电发放。
棘上韧带以及可能其他脊柱韧带中的变形或应力可募集多裂肌力量，使一至三个腰椎运动节段变硬并防止不稳定。当施加可能对韧带造成永久性损伤的负荷时，会出现强烈的肌肉活动，表明韧带过载可能导致肌肉痉挛活动以及可能的疼痛。
