How does lumbar degenerative disc disease affect the disc deformation at the cephalic levels in vivo?
How does lumbar degenerative disc disease affect the disc deformation at the cephalic levels in vivo?
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DOI：
10.1097/brs.0b013e3181f79e93
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发表时间：
2011-04-20
期刊：
影响因子：
3
通讯作者：
Li G
中科院分区：
文献类型：
--
作者：
Wang S;Xia Q;Passias P;Li W;Wood K;Li G
病例对照研究。.评价腰椎退行性椎间盘疾病（DDD）在腰椎活动范围结束时对相邻节段和相邻节段上一节段椎间盘变形的影响。据报道，在DDD患者中，邻近患病节段的椎间盘更容易退化。尽管生物力学改变被认为是椎间盘突出的致病因素，但关于DDD患者相邻椎间盘变形特征的报道很少。10名有症状的患者，椎间盘源性腰痛之间的L4和S1和健康的椎间盘在头段参与。在我们以前的研究中招募的8名健康受试者被用作参考比较。采用磁共振成像和双透视成像技术，在功能体位下获得两组L3-L4（退变椎间盘的头侧相邻节段）和L2-L3（相邻节段上方的一个节段）腰椎间盘的体内运动学。在两个椎间盘节段比较两组之间的变形特征，包括最小变形面积（定义为小于5%）、椎间盘中心变形以及最大拉伸和剪切变形。在DDD患者中，L3-L4和L2-L3的最小椎间盘变形面积明显小于健康受试者（平均为18%，而总椎间盘面积为45%）。L2-L3和L3-L4椎间盘在所有姿势下都比健康受试者承受更大的拉伸和剪切变形。与健康受试者相比，最大拉伸变形高出23%（站立时的局部椎间盘高度），最大剪切变形高出约25%至40%（站立时的局部椎间盘高度）。与健康受试者相比，手术治疗前DDD患者相邻节段和上一节段的椎间盘在腰椎活动范围结束时经历了更高的拉伸和剪切变形。在头段较大的椎间盘变形，否则无法使用传统的磁共振成像技术检测。未来的研究应该调查手术治疗的效果，如融合或椎间盘置换，在腰椎活动范围结束时相邻节段的生物力学。
Case-control study. . To evaluate the effect of lumbar degenerative disc disease (DDD) on the disc deformation at the adjacent level and at the level one above the adjacent level during end ranges of lumbar motion. It has been reported that in patients with DDD, the intervertebral discs adjacent to the diseased levels have a greater tendency to degenerate. Although altered biomechanics have been suggested to be the causative factors, few data have been reported on the deformation characteristics of the adjacent discs in patients with DDD. Ten symptomatic patients with discogenic low back pain between L4 and S1 and with healthy discs at the cephalic segments were involved. Eight healthy subjects recruited in our previous studies were used as a reference comparison. The in vivo kinematics of L3–L4 (the cephalic adjacent level to the degenerated discs) and L2–L3 (the level one above the adjacent level) lumbar discs of both groups were obtained using a combined magnetic resonance imaging and dual fluoroscopic imaging technique at functional postures. Deformation characteristics, in terms of areas of minimal deformation (defined as less than 5%), deformations at the center of the discs, and maximum tensile and shear deformations, were compared between the two groups at the two disc levels. In the patients with DDD, there were significantly smaller areas of minimal disc deformation at L3–L4 and L2–L3 than the healthy subjects (18% compared with 45% of the total disc area, on average). Both L2–L3 and L3–L4 discs underwent larger tensile and shear deformations in all postures than the healthy subjects. The maximum tensile deformations were higher by up to 23% (of the local disc height in standing) and the maximum shear deformations were higher by approximately 25% to 40% (of the local disc height in standing) compared with those of the healthy subjects. Both the discs of the adjacent level and the level one above experienced higher tensile and shear deformations during end ranges of lumbar motion in the patients with DDD before surgical treatments when compared with the healthy subjects. The larger disc deformations at the cephalic segments were otherwise not detectable using conventional magnetic resonance imaging techniques. Future studies should investigate the effect of surgical treatments, such as fusion or disc replacement, on the biomechanics of the adjacent segments during end ranges of lumbar motion.