Altered spinal motion in low back pain associated with lumbar strain and spondylosis.
Altered spinal motion in low back pain associated with lumbar strain and spondylosis.
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DOI：
10.1055/s-0033-1341640
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发表时间：
2013-04-01
期刊：
影响因子：
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通讯作者：
Komistek, Richard D
中科院分区：
文献类型：
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作者：
Cheng, Joseph S;Carr, Christopher B;Komistek, Richard D
研究设计我们提出了一个患者特定的计算机模型，用于将二维（2D）透视运动数据转换为三维（3D）体内生物力学运动数据。本研究的目的是确定有和无急性腰痛患者的体内生物力学差异。目前腰椎的动态成像包括屈伸静态X线片，其对平面外运动缺乏敏感性，并且提供关于整体脊柱运动的不完整信息。使用一种新的技术，在平面内和耦合的平面外旋转运动的量化在腰椎。方法共有30名参与者-10名健康无症状受试者，10名放射学上无脊椎病的腰痛患者，以及10名放射学上有脊椎病的腰痛患者-进行动态荧光透视，采用3D到2D图像配准技术创建3D，患者特定的骨模型，使用最大绝对旋转幅度和旋转路径分析体内运动学。结果下腰痛患者的平均整体平面内旋转（L1-L5）小于无症状患者，主要是伸展时的运动丧失。下腰痛患者的平面外旋转也明显更大，与无症状受试者相比，每个节段的平面外旋转运动增加5.5度（无椎关节强硬）和7.1度（椎关节强硬）。结论腰背痛患者的腰椎节段间平面外运动比无症状的健康受试者更大。传统的屈伸位X线片不足以评估腰椎劳损的运动模式，3D体内脊柱运动评估可能阐明异常椎体运动与临床显著腰痛的相关性。
Study DesignWe present a patient-specific computer model created to translate two-dimensional (2D) fluoroscopic motion data into three-dimensional (3D) in vivo biomechanical motion data. ObjectiveThe aim of this study is to determine the in vivo biomechanical differences in patients with and without acute low back pain. Current dynamic imaging of the lumbar spine consists of flexion-extension static radiographs, which lack sensitivity to out-of-plane motion and provide incomplete information on the overall spinal motion. Using a novel technique, in-plane and coupled out-of-plane rotational motions are quantified in the lumbar spine. MethodsA total of 30 participants-10 healthy asymptomatic subjects, 10 patients with low back pain without spondylosis radiologically, and 10 patients with low back pain with radiological spondylosis-underwent dynamic fluoroscopy with a 3D-to-2D image registration technique to create a 3D, patient-specific bone model to analyze in vivo kinematics using the maximal absolute rotational magnitude and the path of rotation. ResultsAverage overall in-plane rotations (L1-L5) in patients with low back pain were less than those asymptomatic, with the dominant loss of motion during extension. Those with low back pain also had significantly greater out-of-plane rotations, with 5.5 degrees (without spondylosis) and 7.1 degrees (with spondylosis) more out-of-plane rotational motion per level compared with asymptomatic subjects. ConclusionsSubjects with low back pain exhibited greater out-of-plane intersegmental motion in their lumbar spine than healthy asymptomatic subjects. Conventional flexion-extension radiographs are inadequate for evaluating motion patterns of lumbar strain, and assessment of 3D in vivo spinal motion may elucidate the association of abnormal vertebral motions and clinically significant low back pain.