Impaired lumbar movement perception in association with postural stability and motor- and somatosensory-evoked potentials in lumbar spinal stenosis
Impaired lumbar movement perception in association with postural stability and motor- and somatosensory-evoked potentials in lumbar spinal stenosis
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DOI：
10.1097/00007632-200205010-00019
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发表时间：
2002-05-01
期刊：
影响因子：
3
通讯作者：
Airaksinen, O
中科院分区：
文献类型：
--
作者：
Leinonen, V;Määttä, S;Airaksinen, O
研究设计.腰椎狭窄症患者不同神经生理学检查结果之间相关性的描述性研究。评估感觉腰椎位置变化的能力以及腰椎运动感知、姿势稳定性、运动诱发电位和体感诱发电位之间的关系。腰痛患者的姿势控制和腰椎本体感觉受损。改变的运动诱发电位和体感诱发电位已经常观察到腰椎狭窄症。该研究包括26例临床和影像学诊断为腰椎管狭窄症的患者。在先前确认的电动躯干旋转装置中，在坐姿下评估了他们感知腰椎旋转的能力。以运动方向指示能力和运动幅度指示能力作为判断腰椎旋转运动能力的指标。用垂直测力台测量姿势稳定性。经颅和腰电刺激诱发运动诱发电位，记录胫前肌;经皮电刺激踝部胫神经诱发体感诱发电位。20例患者（76.9%; P = 0.006）报告了错误的移动方向。此外，患者始终将运动感觉定位在肩部而不是腰部。运动诱发电位和体感诱发电位改变者分别为11例和16例。运动诱发电位异常与运动知觉和姿势稳定性受损的相关性不一致，而体感诱发电位异常与其他结果无关。许多腰椎管狭窄症患者难以感知腰椎旋转运动，这可能表明本体感受能力受损。异常运动诱发电位和体感诱发电位也常见于腰椎管狭窄症，但不一定发生在感觉躯干运动能力异常的同一患者中。这些新的发现增加了我们对腰椎管狭窄症病理生理的理解。
Study Design. A descriptive study of the associations between different neurophysiologic findings in patients with lumbar spinal stenosis.Objectives. To evaluate the ability to sense a change in lumbar position and the associations between lumbar movement perception, postural stability, and motor-evoked potentials and somatosensory-evoked potentials.Summary of Background Data. Patients with low back pain have impaired postural control and impaired lumbar proprioception. Altered motor-evoked potentials and somatosensory-evoked potentials have been often observed in lumbar spinal stenosis.Methods. The study included 26 patients with clinically and radiologically diagnosed lumbar spinal stenosis. Their ability to sense lumbar rotation was assessed in a previously validated motorized trunk rotation unit in the seated position. The abilities to indicate the movement direction and the movement magnitude were used as indexes of the ability to sense the lumbar rotatory movement. The postural stability was measured with a vertical force platform. The motor-evoked potentials were elicited by transcranial and lumbar stimulation and recorded from anterior tibialis muscles, The somatosensory-evoked potentials were elicited by transcutaneous electrical stimulation of the tibial nerve at the ankle.Results. Twenty patients (76.9%; P = 0.006) reported the wrong movement direction. Furthermore, the patients consistently localized the movement sensation in their shoulders instead of the lumbar region. The altered motor-evoked potentials and somatosensory-evoked potentials were observed in 11 and 16 patients, respectively. Abnormal motor-evoked potentials had inconsistent associations with impaired movement perception and postural stability and abnormal somatosensory-evoked potentials had no associations with other findings.Conclusions. Many patients with lumbar spinal stenosis have difficulties in sensing the lumbar rotational movement, which may indicate impaired proprioceptive abilities. Abnormal motor-evoked potentials and somatosensory-evoked potentials are also frequent in lumbar spinal stenosis but do not necessarily occur in the same patients as the abnormal ability to sense trunk movement. These new findings add to our understanding of the pathophysiology of lumbar spinal stenosis.