Biomechanical and neurophysiological responses to spinal manipulation in patients with lumbar radiculopathy
Biomechanical and neurophysiological responses to spinal manipulation in patients with lumbar radiculopathy
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DOI：
10.1016/j.jmpt.2003.11.021
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发表时间：
2004-01-01
影响因子：
1.3
通讯作者：
Gunzburg, R
中科院分区：
文献类型：
--
作者：
Colloca, CJ;Keller, TS;Gunzburg, R
目的：本研究的目的是量化在体内脊椎运动和神经生理反应在脊柱manipulation.Methods：9例腰椎减压手术参与了这项研究。对腰椎小关节（FJ）和棘突（SP）进行脊柱操作性推力（SMT）（类似于5 ms; 30 N [假手术]、88 N、117 N和150 N [最大值]），邻近骨内钉，并连接三轴加速计和双极电极，环绕SI脊神经根。计算每个SMT的峰值基线振幅复合动作电位（CAP）反应和峰-峰振幅轴向（AX）、后-前（PA）和内侧-外侧（ML）加速时间和位移时间反应。内主题的接触点和力的大小对椎体位移和CAP responses的影响进行了统计分析performed.Results：SMT（大于或等于88 N）导致显着更大的峰到峰ML，PA和AX椎体位移与假推力相比（P < .002）。与SPs相比，将SMT输送到FJ导致ML运动增加约3倍（P <0.001）。与应用于FJ的SMT相比，SP上的SMT导致显著更大的AX位移（P < .05）。75%的SMTs导致了积极的CAP反应，平均潜伏期为12.0 ms。总的来说，CAP反应的幅度是显着更大的最大设置SMTs相比sham（P <0.01）。结论：在人类受试者的脉冲SMTs刺激脊神经根反应，在时间上与脊椎运动的开始。进一步的工作，包括检查SMT的频率和力持续时间依赖性，是必要的，以阐明增强或缺乏CAP反应的患者的临床相关性。
Objective: The purpose of this study was to quantify in vivo vertebral motions and neurophysiological responses during spinal manipulation.Methods: Nine patients undergoing lumbar decompression surgery participated in this study. Spinal manipulative thrusts (SMTs) (similar to5 ms; 30 N [Sham], 88 N, 117 N, and 150 N [max]) were administered to lumbar spine facet joints (FJs) and spinous processes (SPs) adjacent to an intraosseous pin with an attached triaxial accelerometer and bipolar electrodes cradled around the SI spinal nerve roots. Peak baseline amplitude compound action potential (CAP) response and peak-peak amplitude axial (AX), posterior-anterior (PA), and medial-lateral (ML) acceleration time and displacement time responses were computed for each SMT. Within-subject statistical analyses of the effects of contact point and force magnitude on vertebral displacements and CAP responses were performed.Results: SMTs ( greater than or equal to 88 N) resulted in significantly greater peak-to-peak ML, PA, and AX vertebral displacements compared with sham thrusts (P < .002). SMTs delivered to the FJs resulted in approximately 3-fold greater ML motions compared with SPs (P < .001). SMTs over the SPs resulted in significantly greater AX displacements compared with SMTs applied to the FJs (P < .05). Seventy-five percent of SMTs resulted in positive CAP responses with a mean latency of 12.0 ms. Collectively, the magnitude of the CAP responses was significantly greater for max setting SMTs compared with sham (P < .01).Conclusions: Impulsive SMTs in human subjects were found to stimulate spinal nerve root responses that were temporally related to the onset of vertebral motion. Further work, including examination of the frequency and force duration dependency of SMT, is necessary to elucidate the clinical relevance of enhanced or absent CAP responses in patients.