Z Joint Changes in Low Back Pain Following Adjusting

调整后腰痛的 Z 关节变化

• 批准号: 7035698
• 负责人: Gregory D Cramer
• 金额: $ 37万
• 依托单位: NATIONAL UNIVERSITY OF HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-30 至 2009-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7035698
• 关键词: analgesia; backache; bioimaging /biomedical imaging; chiropractic; chordate locomotion; clinical research; human subject; joints; magnetic resonance imaging; posture; vertebrae

DESCRIPTION (provided by applicant): The purpose of this continuation project (NIH/NCCAM # RO1 AT00123) is to use MRI to evaluate gapping of the zygapophysial (Z) joints following side-posture positioning and side-posture spinal adjusting in subjects with acute low back pain (LBP). A fundamental hypothesis of one of the beneficial effects of chiropractic spinal adjusting is that adhesions, developing in the Z joints following hypomobility of these structures, are thought to be alleviated by separation (gapping) of the Z joints through spinal adjusting. In the previous study, side-posture adjusting was found to gap the Z joints in healthy subjects. The aim of this study is to determine if differences can be measured in the L4/L5 and L5/S1 Z joint spaces during side-posture positioning and after lumbar side-posture spinal adjusting of 112 subjects with acute LBP, and to determine if the amount of gapping is related to pain relief and improved function. Following 2 weeks of treatment, the subjects will be temporarily randomized into one of 4 MRI groups: 1) neutral positioning, followed by side-posture positioning (most painful side up); 2) neutral positioning, followed by side-posture adjusting (most painful side up), followed by neutral positioning; 3) neutral positioning, followed by side-posture adjusting (most painful side up) and remaining in side-posture; and 4) (pure control group) neutral positioning, followed by very brief side-posture positioning, followed by neutral positioning. MRI scans will be taken with the subjects in the original neutral position and in the final position. Both MRI scans will be conducted consecutively over approximately 30 minutes (12:19 minutes per scan). All spinal adjustments given during this appointment will be performed directly on the MRI gantry table after the first scan. A second MRI appointment will occur 2 weeks later after 2 weeks of treatment. At the second MRI appointment, subjects will be assigned to the MRI group opposite to the one to which they were randomized during the first MRI appointment. Three observers, blinded to each other and to subject grouping, will make anterior-to-posterior measurements (A-P gap) of the Z joints directly from the MRI scans. The gapping difference between the second and first scans of each MRI appointment will be analyzed to determine if differences exist between the 4 groups and if the amount of gapping is related to relief of pain (difference in Visual Analog Scale from initial exam to MRI appointment) and disability (difference in Bournemouth Questionnaire scores). The results of this study will be used to increase understanding of the mechanism of action of lumbar side posture adjusting and side-posture positioning in acute LBP patients.

描述（由申请人提供）：本延续项目（NIH/NCCAM # RO1 AT00123）的目的是使用MRI评估急性腰痛（LBP）受试者侧位定位和侧位脊柱调整后关节间隙。关于脊椎调节的一个有益效果的基本假设是，由于Z关节结构不灵活而产生的粘连被认为可以通过脊柱调节使Z关节分离（间隙）而得到缓解。在以往的研究中发现，侧位调整对健康受试者的Z关节间隙有影响。本研究的目的是确定112例急性腰痛患者侧位定位和腰椎侧位脊柱调节后L4/L5和L5/S1 Z关节间隙的差异，并确定间隙的大小是否与疼痛缓解和功能改善有关。治疗2周后，受试者将临时随机分为4个MRI组：1)中立位，其次是侧位（最痛的侧朝上）；2)中立位，然后侧位调整（最痛的侧向上），然后中立位；3)中立体位，然后调整侧位（最痛的侧朝上），保持侧位；4)（纯对照组）中性体位，然后是非常短暂的侧位，然后是中性体位。MRI扫描将在受试者处于原始中立位和最终位置时进行。两次MRI扫描将连续进行约30分钟（每次扫描12:19分钟）。在此预约期间给予的所有脊柱调整将在第一次扫描后直接在MRI龙门台上进行。第二次核磁共振检查将在治疗2周后2周进行。在第二次MRI预约时，受试者将被分配到与第一次MRI预约时随机分配到的组相反的MRI组。三个观察者，彼此不知道，也不知道受试者分组，将直接从MRI扫描对Z关节进行前后测量（A-P间隙）。将分析每次MRI预约的第二次和第一次扫描之间的间隙差异，以确定四组之间是否存在差异，以及间隙的大小是否与疼痛的缓解（从初次检查到MRI预约的视觉模拟量表的差异）和残疾（伯恩茅斯问卷得分的差异）有关。本研究的结果将有助于加深对急性腰痛患者腰部侧位调整和侧位定位的作用机制的理解。