Abstract：
OBJECTIVE: In vivo studies of continuous lumbar sagittal plane motion have found passive intervertebral motion to be more uneven in patients with chronic nonspecific low back pain (CNSLBP) than healthy controls, but the mechanisms are unclear. This study aimed to compare patients with CNSLBP with a matched group of pain-free controls for intervertebral restraint during passive recumbent bending.
METHODS: Seventeen patients with CNSLBP and minimal disc degeneration who had quantitative fluoroscopy investigations were matched to 17 healthy controls from a database acquired using the same imaging protocol. The entire database (n = 136) was examined for clustering of peaking times, magnitudes and ROM of the first derivatives of the intervertebral angle/motion curves (PTFD, PMFD and ROM) during flexion and return that might introduce confounding. The groups were then compared for differences in these variables.
RESULTS: There were significant segmental ROM differences among clusters in the database when PMFD and ROM were used as clustering variables, indicating heterogeneity. However, in the patient-control study, it was PTFD (velocity) that differentiated the groups. At L5-S1, this was at 10.82% of the motion path compared with 25.06% in the controls (p = 0.0002). For L4-5, PTFD was at 23.42% of the motion path in patients and 16.33% in controls (p = 0.0694) suggesting a reduced initial bending moment there. There were no significant differences for PMFD or ROM.
CONCLUSIONS: Peaking time of passive intervertebral velocity occurs early at L5-S1 in patients with CNSLBP; however, these findings should be treated with caution pending their replication. Future studies should explore relationships with altered disc pressures and biochemistry. Usefulness for monitoring regenerative disc therapies should be considered.
METHODS: Seventeen patients with CNSLBP and minimal disc degeneration who had quantitative fluoroscopy investigations were matched to 17 healthy controls from a database acquired using the same imaging protocol. The entire database (n = 136) was examined for clustering of peaking times, magnitudes and ROM of the first derivatives of the intervertebral angle/motion curves (PTFD, PMFD and ROM) during flexion and return that might introduce confounding. The groups were then compared for differences in these variables.
RESULTS: There were significant segmental ROM differences among clusters in the database when PMFD and ROM were used as clustering variables, indicating heterogeneity. However, in the patient-control study, it was PTFD (velocity) that differentiated the groups. At L5-S1, this was at 10.82% of the motion path compared with 25.06% in the controls (p = 0.0002). For L4-5, PTFD was at 23.42% of the motion path in patients and 16.33% in controls (p = 0.0694) suggesting a reduced initial bending moment there. There were no significant differences for PMFD or ROM.
CONCLUSIONS: Peaking time of passive intervertebral velocity occurs early at L5-S1 in patients with CNSLBP; however, these findings should be treated with caution pending their replication. Future studies should explore relationships with altered disc pressures and biochemistry. Usefulness for monitoring regenerative disc therapies should be considered.
摘要：
目的：连续腰椎矢状面运动的体内研究发现，慢性非特异性下腰痛（CNSLBP）患者的被动椎间运动比健康对照组更不均匀，但机制尚不清楚。这项研究旨在比较CNSLBP患者与一组无痛对照组在被动卧位弯曲过程中的椎间约束。
方法：从使用相同成像方案获得的数据库中，对17名接受定量透视检查的CNSLBP和轻微椎间盘退变患者与17名健康对照进行匹配。检查了整个数据库(n=136)的峰值时间聚类，椎间角度/运动曲线的一阶导数的幅度和ROM（PTFD，PMFD和ROM）在弯曲和返回期间可能会引起混淆。然后比较各组在这些变量中的差异。
结果：当使用PMFD和ROM作为聚类变量时，数据库中的聚类之间存在显着的分段ROM差异，表明异质性。然而,在病人对照研究中，是PTFD（速度）区分了各组。在L5-S1处,与对照中的25.06%相比,这在运动路径的10.82%处(p=0.0002)。对于L4-5，PTFD在患者中处于运动路径的23.42％，在对照组中为16.33％（p=0.0694），表明那里的初始弯矩减小。PMFD或ROM没有显着差异。
结论：CNSLBP患者被动椎间速度的峰值时间早于L5-S1。这些发现在复制之前应谨慎对待.未来的研究应该探索与改变的椎间盘压力和生物化学的关系。应考虑监测再生椎间盘疗法的有用性。
方法：从使用相同成像方案获得的数据库中，对17名接受定量透视检查的CNSLBP和轻微椎间盘退变患者与17名健康对照进行匹配。检查了整个数据库(n=136)的峰值时间聚类，椎间角度/运动曲线的一阶导数的幅度和ROM（PTFD，PMFD和ROM）在弯曲和返回期间可能会引起混淆。然后比较各组在这些变量中的差异。
结果：当使用PMFD和ROM作为聚类变量时，数据库中的聚类之间存在显着的分段ROM差异，表明异质性。然而,在病人对照研究中，是PTFD（速度）区分了各组。在L5-S1处,与对照中的25.06%相比,这在运动路径的10.82%处(p=0.0002)。对于L4-5，PTFD在患者中处于运动路径的23.42％，在对照组中为16.33％（p=0.0694），表明那里的初始弯矩减小。PMFD或ROM没有显着差异。
结论：CNSLBP患者被动椎间速度的峰值时间早于L5-S1。这些发现在复制之前应谨慎对待.未来的研究应该探索与改变的椎间盘压力和生物化学的关系。应考虑监测再生椎间盘疗法的有用性。
