Concerns related to the accurate identification of anterior derangement syndrome in mechanical diagnosis and therapy for low back pain: A case report.
Concerns related to the accurate identification of anterior derangement syndrome in mechanical diagnosis and therapy for low back pain: A case report.
复制标题
腰痛机械诊断和治疗中与准确识别前部紊乱综合征相关的担忧：病例报告。
DOI：
10.1080/09593985.2018.1488906
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发表时间：
2019
影响因子：
2
通讯作者：
Stephen May
中科院分区：
文献类型：
--
作者：
Takasaki Hiroshi;Stephen May
背景在机械诊断和治疗（MDT）中，下背痛（LBP）患者被分为亚组以指导治疗策略。一个常见的亚组，其中症状改善与腰椎伸展被标记为后方紊乱综合征。一个不太常见的亚组，症状改善与腰椎屈曲被标记为前紊乱syndrome.Case PresentationThe患者是一个23岁的女子间歇性LBP和左下肢不适最初诊断为后紊乱综合征。在初次和第二次会诊时，处方了姿势矫正和腰椎伸展的家庭锻炼。然而，在第三次会诊时，持续的腰椎伸展显示症状和功能恶化，这导致了前路紊乱综合征的诊断。通过6周的腰屈练习实现了完全恢复。结果患者在日常生活中佩戴LUMOback，这是一种测量骨盆角度和加速度的可穿戴设备，在初次MDT咨询前1周和出院前6周佩戴。姿势评分（%）是一周内中性骨盆倾斜的时间比例。在这个病人中，姿势评分下降大于最小可检测的变化11.7%时，MDT分类改变为前derangement.ConclusionsThis病例报告表明持续负荷的重要性，以确定正确的紊乱综合征，和后续会议，以确认或拒绝通过监测症状和功能变化的初步诊断仔细。习惯性姿势可能与症状的减轻和加重有关。
BackgroundIn Mechanical Diagnosis and Therapy (MDT), patients with low back pain (LBP) are classified into subgroups to guide a management strategy. A common subgroup where symptoms improve with lumbar extension is labeled posterior derangement syndrome. A less common subgroup where symptoms improve with lumbar flexion is labeled anterior derangement syndrome.Case PresentationThe patient was a 23-year-old woman with intermittent LBP and discomfort over the left lower extremity was initially diagnosis with posterior derangement syndrome. At the initial and second consultations, postural correction and home exercises with lumbar extension were prescribed. However, at the third consultation, sustained lumbar extension revealed worsening of symptoms and function, which resulted in a revised diagnosis of anterior derangement syndrome. Complete recovery was achieved using exercises with lumbar flexion over 6 weeks.OutcomesThe patient wore the LUMOback in daily life, which is a wearable device measuring pelvic angle and acceleration, for 1 week before the initial MDT consultation and for 6 weeks until discharge. The posture scores (%) is the proportion of time in a week with neutral pelvic tilt. In this patient, the posture score decreased greater than a minimum detectable change of 11.7% when MDT classification changed to anterior derangement.ConclusionsThis case report indicates the importance of sustained loading to identify the correct derangement syndrome, and follow-up sessions to confirm or reject the initial diagnosis by monitoring symptom and functional changes carefully. Habitual posture may be associated with reduction and aggravation of symptoms.