Clinical spinal instability and low back pain
Clinical spinal instability and low back pain
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DOI：
10.1016/s1050-6411(03)00044-0
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发表时间：
2003-08-01
影响因子：
2.5
通讯作者：
Panjabi, MM
中科院分区：
文献类型：
--
作者：
Panjabi, MM
临床不稳定是引起腰痛的重要原因。虽然关于其定义存在一些争议，但最广泛的观点是脊柱运动正常模式的丧失导致疼痛和/或神经功能障碍。脊柱的稳定系统可以分为三个子系统：（1）脊柱;（2）脊柱肌肉;和（3）神经控制单元。脊柱的大量生物力学研究已经提供了对脊柱的各种组成部分在提供脊柱稳定性中的作用的洞察。中性区被认为是一个更敏感的参数，比活动范围记录的影响，机械不稳定的脊柱损伤和重新稳定的脊柱骨赘形成，融合或肌肉稳定。临床研究表明，应用外固定器治疗脊柱疼痛节段可显著减轻疼痛。研究的体外模拟结果发现，这很可能是中性区的减少，这是减轻疼痛的原因。提出了一个中性区与疼痛有关的假说。脊柱肌肉为脊柱提供了显著的稳定性，如体外实验和数学模型所示。关于神经肌肉控制系统的作用，在腰痛患者中发现身体摇摆增加，表明肌肉控制系统效率较低，提供所需脊柱稳定性的能力降低。(C)2003爱思唯尔科技有限公司版权所有。
Clinical instability is an important cause of low back pain. Although there is some controversy concerning its definition, it is most widely believed that the loss of normal pattern of spinal motion causes pain and/or neurologic dysfunction. The stabilizing system of the spine may be divided into three subsystems: (1) the spinal column; (2) the spinal muscles; and (3) the neural control unit. A large number of biomechanical studies of the spinal column have provided insight into the role of the various components of the spinal column in providing spinal stability. The neutral zone was found to be a more sensitive parameter than the range of motion in documenting the effects of mechanical destabilization of the spine caused by injury and restabilization of the spine by osteophyle formation, fusion or muscle stabilization. Clinical studies indicate that the application of an external fixator to the painful segment of the spine can significantly reduce the pain. Results of an in vitro simulation of the study found that it was most probably the decrease in the neutral zone, which was responsible for pain reduction. A hypothesis relating the neutral zone to pain has been presented. The spinal muscles provide significant stability to the spine as shown by both in vitro experiments and mathematical models. Concerning the role of neuromuscular control system, increased body sway has been found in patients with low back pain, indicating a less efficient muscle control system with decreased ability to provide the needed spinal stability. (C) 2003 Elsevier Science Ltd. All rights reserved.