Z Joint Changes in Low Back Pain Following Adjusting

描述（由申请方提供）：本延续项目（NIH/NCCAM #RO1 AT00123）的目的是使用MRI评价急性腰痛（LBP）受试者在侧位定位和侧位脊柱调整后关节突（Z）关节的间隙。脊椎按摩疗法脊柱调整的有益效果之一的基本假设是，在这些结构的低活动性之后在Z关节中发展的粘连被认为通过脊柱调整通过Z关节的分离（间隙）而减轻。在先前的研究中，发现侧姿势调整会使健康受试者的Z关节间隙。本研究的目的是确定是否可以测量的差异，在L4/L5和L5/S1 Z关节间隙在侧位定位和腰椎侧位脊柱调整后的112例急性LBP受试者，并确定是否间隙量与疼痛缓解和改善功能。治疗2周后，受试者将暂时随机分配至4个MRI组之一：1）中立位，随后为侧位（最痛苦的一面向上）; 2）中立的立场，其次是侧姿势调整（最痛侧向上），其次是中立位; 3）中立位，其次是侧位调整（最疼痛的一侧向上）并保持侧位;和4）（纯对照组）中性定位，然后是非常短暂的侧位定位，然后是中性定位。将在受试者处于原始中立位和最终位置时进行MRI扫描。两次MRI扫描将在约30分钟内连续进行（每次扫描12：19分钟）。在首次扫描后，将在MRI机架床上直接进行本次预约期间的所有脊柱调整。第二次MRI预约将在治疗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预约期间随机分配的MRI组相反的MRI组。三名观察员（彼此和受试者分组均设盲）将直接从MRI扫描中对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4组之间是否存在差异，以及间隙量是否与疼痛缓解（从初始检查到MRI预约的视觉模拟量表差异）和残疾（伯恩茅斯问卷评分差异）相关。本研究的结果将被用来增加对急性LBP患者的腰椎侧位调整和侧位定位的作用机制的理解。

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.