Comparison of human lumbar facet joint capsule strains during simulated high-velocity, low-amplitude spinal manipulation versus physiological motions.
Comparison of human lumbar facet joint capsule strains during simulated high-velocity, low-amplitude spinal manipulation versus physiological motions.
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DOI：
10.1016/j.spinee.2004.11.006
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发表时间：
2005-05-01
期刊：
影响因子：
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通讯作者：
Khalsa, Partap S
中科院分区：
文献类型：
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作者：
Ianuzzi, Allyson;Khalsa, Partap S
背景情况：脊柱推拿（SM）是治疗下腰痛（LBP）的有效方法，并且理论上SM通过刺激腰椎小关节囊（FJC）中的机械敏感神经元诱导有益的神经生理学效应。目的：本研究的目的是确定模拟SM期间人类腰椎FJC应变是否与生理运动期间发生的应变不同。腰椎FJC应变测量在人体尸体脊柱标本在生理运动和模拟SM在实验室setting.METHODS：标本进行了测试，在位移控制的生理运动的屈曲，伸展，侧弯，和轴向旋转。使用操作部位（L3、L4和L5）、脉冲速度（5、20和50 mm/s）和预扭矩大小（在T12处施加以模拟患者位置; 0、5、10 Nm）的组合模拟SM。FJC应变和椎体运动（使用六个自由度）在两个加载protocols.RESULTS：在SM期间，施加的负载在SM在体内测量的范围内。椎体平移主要发生在施加载荷的方向上，无论操作部位如何，其幅度相似。SM期间的椎体旋转和FJC应变幅度在生理运动期间发生的范围内。在一个给定的FJC，操作提供远端引起的胶囊应变类似的幅度时发生的操作被应用于proximate.CONCLUSIONS：FJC应变幅度在SM的生理范围内，这表明SM是生物力学安全的。使用SM成功治疗LBP患者可能不需要精确的节段特异性，因为SM期间给定FJC处的应变幅度不取决于操作部位。
BACKGROUND CONTEXT: Spinal manipulation (SM) is an effective treatment for low back pain (LBP), and it has been theorized that SM induces a beneficial neurophysiological effect by stimulating mechanically sensitive neurons in the lumbar facet joint capsule (FJC).PURPOSE: The purpose of this study was to determine whether human lumbar FJC strains during simulated SM were different from those that occur during physiological motions.STUDY DESIGN/SETTING: Lumbar FJC strains were measured in human cadaveric spine specimens during physiological motions and simulated SM in a laboratory setting.METHODS: Specimens were tested during displacement-controlled physiological motions of flexion, extension, lateral bending, and axial rotations. SM was simulated using combinations of manipulation site (L3, L4, and L5), impulse speed (5, 20, and 50 mm/s), and pre-torque magnitude (applied at T12 to simulate patient position; 0, 5, 10 Nm). FJC strains and vertebral motions (using six degrees of freedom) were measured during both loading protocols.RESULTS: During SM, the applied loads were within the range measured during SM in vivo. Vertebral translations occurred primarily in the direction of the applied load, and were similar in magnitude regardless of manipulation site. Vertebral rotations and FJC strain magnitudes during SM were within the range that occurred during physiological motions. At a given FJC, manipulations delivered distally induced capsule strains similar in magnitude to those that occurred when the manipulation was applied proximally.CONCLUSIONS: FJC strain magnitudes during SM were within the physiological range, suggesting that SM is biomechanically safe. Successful treatment of patients with LBP using SM may not require precise segmental specificity, because the strain magnitudes at a given FJC during SM do not depend upon manipulation site.