Lumbar facet pain: Biomechanics, neuroanatomy and neurophysiology
Lumbar facet pain: Biomechanics, neuroanatomy and neurophysiology
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DOI：
10.1016/0021-9290(96)00023-1
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发表时间：
1996-09-01
影响因子：
2.4
通讯作者：
King, AI
中科院分区：
文献类型：
--
作者：
Cavanaugh, JM;Ozaktay, AC;King, AI
几十年来，特发性腰痛一直困扰着医疗保健从业者。虽然在过去的25年里，对腰椎生物力学的理解有了很大的进步，但导致小关节疼痛的细胞和神经机制还没有得到很好的理解。进行了一系列广泛的实验，以帮助阐明这些机制，并获得更好的了解腰椎小关节疼痛。在人尸体小关节上进行生物力学和神经解剖学研究，在新西兰白色兔上进行神经生理学研究。这些研究提供了以下证据来帮助解释腰椎小关节疼痛的机制：（1）当人类脊柱过伸时，小关节可以承载脊柱上的总压缩载荷的显著量。(2)当脊柱处于极端伸展的生理范围内时，会发生人小关节囊的广泛伸展。(3)腰椎小关节囊内广泛分布有小神经纤维、游离神经末梢和有囊神经末梢，包括含有P物质的神经，P物质是一种假定的疼痛神经调节剂。(4)当小关节囊被拉伸或受到局部压缩力时，低阈值和高阈值机械感受器激发。(5)当关节发炎或暴露于损伤和炎症期间释放的某些化学物质时，小关节和周围肌肉中的神经会发生敏化和兴奋。(6)注射氢化可的松和利多卡因的小关节组织神经活动明显减少。因此，小关节是一个严重受神经支配的区域，受到高应力和应变。由此产生的组织损伤或炎症可能会导致化学物质的释放刺激这些关节中的神经末梢，导致腰痛。版权所有（C）1996 Elsevier Science Ltd.
Idiopathic low back pain has confounded health care practitioners for decades. Although there has been much advance in the understanding of the biomechanics of the lumbar spine over the past 25 years, the cellular and neural mechanisms that lead to Facet pain are not well understood. An extensive series of experiments was undertaken to help elucidate these mechanisms and gain a better understanding of lumbar facet pain. Biomechanic and neuroanatomic studies were performed in human cadaveric Facet joints and neurophysiologic studies were performed in New Zealand White rabbits. These studies provide the following evidence to help explain the mechanisms of lumbar facet pain: (1) The facet joint can carry a significant amount of the total compressive load on the spine when the human spine is hyperextended. (2) Extensive stretch of the human facet joint capsule occurs when the spine is in the physiologic range of extreme extension. (3) An extensive distribution of small nerve fibers and free and encapsulated nerve endings exists in the lumbar facet joint capsule, including nerves containing substance P, a putative neuromodulator of pain. (4) Low and high threshold mechanoreceptors fire when the facet joint capsule is stretched or is subject to localized compressive forces. (5) Sensitization and excitation of nerves in facet joint and surrounding muscle occur when the joint is inflamed or exposed to certain chemicals that are released during injury and inflammation. (6) Marked reduction in nerve activity occurs in Facet tissue injected with hydrocortisone and lidocaine. Thus, the facet joint is a heavily innervated area that is subject to high stress and strain. The resulting tissue damage or inflammation is likely to cause release of chemicals irritating to the nerve endings in these joints, resulting in low back pain. Copyright (C) 1996 Elsevier Science Ltd.