Z Joint Changes in Low Back Pain Following Adjusting

描述(申请人提供)：本延续项目(NIH/NCCAM#RO1 AT00123)的目的是使用MRI评估急性下腰痛(LBP)受试者侧姿势定位和侧姿势脊柱调整后关节突关节(Z)关节间隙的情况。脊神经脊椎调整的有益效果之一的一个基本假设是，在这些结构活动不足后在Z关节发展的粘连，被认为可以通过脊柱调整分离Z关节(缝隙)来缓解。以前的研究发现，在健康受试者中，侧姿势调整可以使Z关节产生间隙。本研究的目的是确定112例急性下腰痛患者在侧位定位和腰椎侧位调整后L4/L5和L5/S1Z关节间隙是否存在差异，以及间隙的大小是否与疼痛缓解和功能改善有关。治疗2周后，受试者将暂时随机分为4组：1)中性体位，然后是侧卧位(最痛的一侧朝上)；2)中立位，然后是侧位调整(最痛的一侧朝上)，然后是中性体位；3)中立位，然后是侧位调整(最痛的一侧朝上)，并保持侧位；4)(纯对照组)中立位，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姿势和最终姿势的情况下进行。两次MRI扫描将在大约30分钟内连续进行(每次扫描12：19分钟)。在第一次扫描后，所有在预约期间提供的脊柱调整将直接在MRI台架上进行。第二次核磁共振检查将在治疗2周后的2周后进行。在第二次MRI预约时，受试者将被分配到MRI组，与他们在第一次MRI预约期间被随机分配到的组相反。三名观察者彼此盲目，并对受试者分组，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预约的第二次扫描和第一次扫描之间的差距，以确定4组之间是否存在差异，以及差距的大小是否与疼痛缓解(从初次检查到MRI预约时视觉模拟评分的差异)和残疾(伯恩茅斯问卷分数的差异)有关。本研究结果将有助于加深对急性腰背痛患者腰椎侧卧位调整和侧位定位作用机制的了解。

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.