Aberrant intervertebral motion in patients with treatment-resistant nonspecific low back pain: a retrospective cohort study and control comparison
Aberrant intervertebral motion in patients with treatment-resistant nonspecific low back pain: a retrospective cohort study and control comparison
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DOI：
10.1007/s00586-018-5666-1
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发表时间：
2018-11-01
影响因子：
2.8
通讯作者：
Breen, Alan
中科院分区：
文献类型：
--
作者：
Breen, Alexander;Mellor, Fiona;Breen, Alan
目的：椎间运动评估已被用于研究背痛抵抗治疗时的机械原因，最近的研究已经确定了区分患者和对照组的椎间运动标记物。然而，这些患者是一个异质性的群体，其中一些人有结构破坏，但这对椎间运动的影响尚不清楚。方法37例难治性腰痛患者行定量透视检查，按年龄和性别与等量无痛对照组相匹配。所有患者均接受被动平卧屈曲评估，包括椎间运动共享不平等（MSI）、变异性（MSV）、松弛和平移。在患者亚组之间、患者与对照组之间以及与单独对照组的标准水平进行比较。结果11例患者行手术或介入治疗，10例患者有椎体滑脱或部部缺损。16个没有中断。患者的中位MSI值（0.30）显著高于对照组（0.27,p=0.010），但MSV值（患者0.08 vs对照组0.08,p=0.791）不显著。接受有创手术的患者的中位MSI值（0.37）高于骨缺损患者（0.30,p=0.018）或无骨折患者（0.28,p=0.0007）。松弛和超过参考限度的翻译在患者中并不普遍。结论治疗难治性非特异性背痛患者的MSI值高于对照组，尤其是接受过脊柱手术的患者。然而，过度松弛、平移和MSV在这些患者中并不常见。因此，MSI应该作为一种疼痛机制进行研究，并在更大的患者群体中作为预后因素和/或治疗目标的可能价值。
Purpose Intervertebral kinematic assessments have been used to investigate mechanical causes when back pain is resistant to treatment, and recent studies have identified intervertebral motion markers that discriminate patients from controls. However, such patients are a heterogeneous group, some of whom have structural disruption, but the effects of this on intervertebral kinematics are unknown.Methods Thirty-seven patients with treatment-resistant back pain referred for quantitative fluoroscopy were matched to an equal number of pain-free controls for age and sex. All received passive recumbent flexion assessments for intervertebral motion sharing inequality (MSI), variability (MSV), laxity and translation. Comparisons were made between patient subgroups, between patients and controls and against normative levels from a separate group of controls.Results Eleven patients had had surgical or interventional procedures, and ten had spondylolisthesis or pars defects. Sixteen had no disruption. Patients had significantly higher median MSI values (0.30) than controls (0.27, p=0.010), but not MSV (patients 0.08 vs controls 0.08, p=0.791). Patients who received invasive procedures had higher median MSI values (0.37) than those with bony defects (0.30, p=0.018) or no disruption (0.28, p=0.0007). Laxity and translation above reference limits were not more prevalent in patients.Conclusion Patients with treatment-resistant nonspecific back pain have greater MSI values than controls, especially if the former have received spinal surgery. However, excessive laxity, translation and MSV are not more prevalent in these patients. Thus, MSI should be investigated as a pain mechanism and for its possible value as a prognostic factor and/or target for treatment in larger patient populations.