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首页> 美国卫生研究院文献>European Spine Journal >Factors affecting disability and physical function in degenerative lumbar spondylolisthesis of L4–5: evaluation with axially loaded MRI
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Factors affecting disability and physical function in degenerative lumbar spondylolisthesis of L4–5: evaluation with axially loaded MRI

机译：影响L4-5退行性腰椎滑脱的残障和身体功能的因素：轴向负荷MRI评估

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摘要

Few studies have investigated the factors related to the disability and physical function in degenerative lumbar spondylolisthesis using axially loaded magnetic resonance imaging (MRI). Therefore, we aimed to investigate the effect of axial loading on the morphology of the spine and the spinal canal in patients with degenerative spondylolisthesis of L4–5 and to correlate morphologic changes to their disability and physical functions. From March 2003 to January 2004, 32 consecutive cases (26 females, 6 males) with degenerative L4–5 spondylolisthesis, grade 1–2, intermittent claudication, and low back pain without sciatica were included in this study. All patients underwent unloaded and axially loaded MRI of the lumbo-sacral spine in supine position to elucidate the morphological findings and to measure the parameters of MRI, including disc height (DH), sagittal translation (ST), segmental angulation (SA), dural sac cross-sectional area (DCSA) at L4–5, and lumbar lordotic angles (LLA) at L1–5 between the unloaded and axially loaded condition. Each patient’s disability was evaluated by the Oswestry Disability Index (ODI) questionnaire, and physical functioning (PF) was evaluated by the Physical Function scale proposed by Stucki et al. (Spine 21:796–803, ). Three patients were excluded due to the presence of neurologic symptoms found with the axially loaded MRI. Finally, a total of 29 (5 males, 24 females) consecutive patients were included in this study. Comparisons and correlations were done to determine which parameters were critical to the patient’s disability and PF. The morphologies of the lumbar spine changed after axially loaded MRI. In six of our patients, we observed adjacent segment degeneration (4 L3–L4 and 2 L5–S1) coexisting with degenerative spondylolisthesis of L4–L5 under axially loaded MRI. The mean values of the SA under pre-load and post-load were 7.14° and 5.90° at L4–L5 (listhetic level), respectively. The mean values of the LLA under pre-load and post-load were 37.03° and 39.28°, respectively. There were significant correlations only between the ODI, PF, and the difference of SA, and between PF and the post-loaded LLA. The changes in SA (L4–L5) during axial loading were well correlated to the ODI and PF scores. In addition, the LLA (L1–L5) under axial loading was well correlated to the PF of patients with degenerative L4–L5 spondylolisthesis. We suggest that the angular instability of the intervertebral disc may play a more important role than neurological compression in the pathogenesis of disability in degenerative lumbar spondylolisthesis.
机译：很少有研究使用轴向负荷磁共振成像（MRI）研究退行性腰椎滑脱中的残疾和身体功能的相关因素。因此，我们旨在研究轴向负荷对L4-5退行性腰椎滑脱患者脊柱和脊柱形态的影响，并将形态变化与其残疾和身体功能相关联。从2003年3月至2004年1月，本研究包括32例L4-5退行性滑脱，1-2级，间歇性，行和无坐骨神经痛的腰痛的连续病例（26例女性，6例男性）。所有患者均在仰卧位进行腰s脊柱的无负荷和轴向负荷MRI检查，以阐明形态学发现并测量MRI参数，包括椎间盘高度（DH），矢状平移（ST），节段性成角（SA），硬脑膜在无载荷和轴向载荷状态之间，囊横截面积（DCSA）为L4–5，腰椎前凸角（LLA）为L1–5。每位患者的残疾均通过Oswestry残疾指数（ODI）问卷进行评估，而身体机能（PF）则采用Stucki等人提出的身体机能量表进行评估。 （脊柱21：796–803，）。由于存在轴向负荷MRI发现的神经系统症状，三名患者被排除在外。最后，本研究共纳入29例（男性5例，女性24例）。进行了比较和关联，以确定哪些参数对患者的残疾和PF至关重要。轴向加载MRI后腰椎的形态发生变化。在我们的六例患者中，我们在轴向负荷MRI下观察到相邻节段变性（4个L3–L4和2个L5–S1）与L4–L5的变性腰椎滑脱并存。在L4-L5（听觉水平）下，前负荷和后负荷下SA的平均值分别为7.14°和5.90°。加载前和加载后的LLA平均值分别为37.03°和39.28°。仅在ODI，PF和SA的差异之间以及PF与加载后LLA之间存在显着的相关性。轴向载荷过程中SA的变化（L4-L5）与ODI和PF得分密切相关。此外，轴向负荷下的LLA（L1-L5）与变性L4-L5腰椎滑脱患者的PF密切相关。我们建议，在退行性腰椎滑脱功能障碍的发病机理中，椎间盘的角度不稳定性可能比神经系统压迫起更重要的作用。

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