A link between parity, trunk muscle function, and degenerative spondylolisthesis

描述(申请人提供)：这项研究将调查怀孕，剖腹产(CS)和其他腹部手术，躯干和腹部肌肉缺乏，以及退行性腰椎滑脱(DS)在老年女性中的关系。关键的问题是，怀孕和/或CS介导的躯干肌肉缺陷是否可能是晚年DS发生的诱因。三个具体目标是确定：(1)产次/CS/其他腹部手术是否与DS相关，(2)躯干肌缺陷与DS相关，(3)产次/CS/其他腹部手术与躯干肌肉缺陷相关。退行性腰部疾病的治疗费用使其成为美国医疗保健经济中最昂贵的5种疾病之一。DS被认为是老年人下腰痛的主要原因之一。到目前为止，女性患DS的比例是男性的3-9倍，还没有明确的解释。以前的研究记录了怀孕和下腰痛之间的关系，并提出腹部肌肉不足是潜在原因。特别值得关注的是CS的影响。在过去的30年里，CS的发病率增加了三倍，并可能在未来几年导致与DS有关的重大公共卫生问题。我们建议对200名DS患者和200名年龄匹配的对照组(5岁年龄组)进行病例对照研究，包括对80名DS患者和80名匹配的对照组的躯干肌肉功能进行更详细的评估。根据矢状位X线片的DS诊断进行分组。这400名受试者将接受一份关于他们的产次、CS、以前的手术和其他潜在协变量的详细问卷。此外，每组80名受试者还将接受腹部和躯干肌肉功能的体检，并对运动控制进行定量评估。体检将包括腹肌和髋关节伸展测试。这些测试检查腹部和脊柱旁肌肉在简单的髋关节屈曲和伸展动作中稳定骨盆和腰椎的能力。运动控制测试将量化对躯干突然扰动的肌肉反射潜伏期，以及在不稳定座椅上平衡时的姿势控制。延迟的肌肉反射反应和糟糕的姿势控制都与下腰痛有关，并构成未来腰痛的易感危险因素。随着时间的推移，运动控制不良可能会导致脊柱不稳定、慢性问题和脊柱退行性变化。所有指标都将被量化(连续或分类)，并用于回归和卡方分析，以检验假设。这项建议的创新方面包括客观地量化肌肉功能，并记录与患有和不患有DS的女性的产次相关的变量，这使得更好地发现可能存在的任何关系。 与公共健康相关：退行性腰部疾病的治疗费用使其成为美国医疗保健经济中最昂贵的5种疾病之一。到目前为止，女性患DS的比例是男性的3-9倍，还没有明确的解释。如果分娩和剖腹产的数量使妇女在晚年容易患上这种情况，积极规划有效的干预战略和教育活动将是谨慎的。

DESCRIPTION (provided by applicant): This study will examine relationships between pregnancy, cesarean section (CS) and other abdominal surgery, trunk and abdominal muscle deficiency, and degenerative spondylolisthesis (DS) in older females. The key question is whether pregnancy and/or CS mediated trunk muscle deficiency could be a precipitating factor in the development of DS later in life. Three specific aims are to determine whether: (1) parity/CS/other abdominal surgeries are associated with DS, (2) trunk muscle deficiency is associated with DS, and (3) parity/CS/other abdominal surgeries are associated with trunk muscle deficiency. The costs associated with the treatment of degenerative low back disease make it one of the top 5 most expensive conditions in the American healthcare economy. DS is considered one of the major causes of low back pain among the older population. Women suffer from DS at a 3-9 times higher rate than men, as yet, without a clear explanation. Previous studies documented relationships between pregnancy and low back pain, and suggested abdominal muscle deficiency as an underlying cause. Of special concern is the effect of CS. The rates of CS rose three-fold over the last 3 decades and may cause significant public health problems regarding DS in coming years. We propose to conduct a case-control study of 200 DS patients and 200 age-matched (in 5 year age groups) controls, including a more detailed assessment of trunk muscle function in 80 DS and 80 matched control subjects. Group designation will be based on a DS diagnosis from a sagittal view x-ray. The 400 subjects will be administered a detailed questionnaire regarding their parity, CS, previous surgeries, and other potential covariates. A subset of 80 subjects from each group will in addition undergo a physical examination of their abdominal and trunk muscle function and quantitative assessment of motor control. Physical exam will include abdominal muscle and hip extension tests. These tests examine the ability of the abdominal and paraspinal muscles to stabilize pelvis and the lumbar spine during simple hip flexion and extension maneuvers. Motor control tests will quantify muscle reflex latencies in response to sudden trunk perturbations, and postural control while balancing on an unstable seat. Both delayed muscle reflex responses and poor postural control are associated with low back pain and constitute predisposing risk factors to future low back problems. Poor motor control could lead to spine instability, chronic problems and degenerative changes in the spine over time. All measures will be quantified (continuous or categorized) and used in the regression and chi-square analyses to test the hypotheses. Innovative aspects of this proposal comprise of quantifying muscle function objectively and documenting variables related to parity in women with and without DS, which gives a better chance of finding any relationships that might exist. PUBLIC HEALTH RELEVANCE: The costs associated with the treatment of degenerative low back disease make it one of the top 5 most expensive conditions in the American healthcare economy. Women suffer from DS at a 3-9 times higher rate than men, as yet, without a clear explanation. If the number of childbirths and cesarean sections predisposes women to this condition later in life, proactive planning of effective intervention strategies and educational campaigns would be prudent.