MULTIFACTOR, QUANTITATIVE ASSESSMENT OF SPINAL STENOSIS

椎管狭窄的多因素定量评估

• 批准号: 6199520
• 负责人: JOHN A HIPP
• 金额: $ 17.78万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-07-17 至 2001-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6199520
• 关键词: X ray; backache; clinical research; computed axial tomography; data collection methodology /evaluation; fluoroscopy; human subject; leg; magnetic resonance imaging; nervous system disorder; sign /symptom; social psychology; spinal cord disorders

Symptoms of low back and leg pain are at least partially responsible for thousands of lost workdays, and 20 to 100 billion dollars in health care costs each year in the United States alone. Numerous distinguished clinicians and researchers have stated that specific causes for symptoms can not be diagnosed in many of these patients. Despite the cost to society and the recognized limitations of current diagnostic techniques, few improved diagnostic techniques have been developed, and even fewer have been proven to be clinically useful. Approximately 20 percent of hospitalized back pain patients are diagnosed with spinal stenosis. This diagnosis is based on the hypothesis that insufficient space available for neural elements in the spine can cause low back and leg pain. This hypothesis is supported by years of clinical experience, yet it is commonly recognized that there are many exceptions. The diagnosis of spinal stenosis is typically based on qualitative assessments made from x-ray, CT and/or MRI data. Limited quantitative guidelines have been described but they are not in widespread use, in part because threshold levels of stenosis that are sensitive and specific for symptoms have never been proven. Technology to reproducibly measure spinal stenosis from common imaging modalities is readily available. Society will benefit from this technology after guidelines for obtaining and using quantitative measurements are validated. New diagnostic tests can be validated using measurements that represent positive and negative findings. Many patients with spinal stenosis have little or no pain in some positions and moderate to severe pain in other positions. These patients may cross a threshold level of stenosis by changing the position of their spine. This important and common clinical observation points to powerful model that can be used to validate quantitative measurements of spinal stenosis, since ach patient can serve as their own control. The specific aims of the proposed research are to identify specific measurements of spinal stenosis that are sensitive and specific for symptoms, and to identify the co-factors that effect the association between spinal stenosis and back or leg pain. Several different quantitative measurements will be made to account for the many possible types of stenosis. Measurements will be made non-invasively three-dimensional computer reconstructions of the spine in a painful position and compared to measurements made with the spine in a less painful position. Psychosocial variables will also be recorded to account for the role of these variables in the relationships between spinal stenosis and symptoms. This investigation will be conducted at a large university based spine center that has an established clinical outcomes program, established access to imaging data, and will use validated measurement techniques. The proposed investigations will provide clinically applicable measurements guidelines for the assessment of spinal stenosis.

腰部和腿部疼痛的症状至少部分是部分 负责数千个损失的工作日和20至1000亿美元 仅在美国，每年的医疗保健费用。许多区分 临床医生和研究人员已经指出，症状的特定原因可以 在许多患者中未被诊断出来。尽管有社会和 当前诊断技术的公认局限性，很少有改进 已经开发了诊断技术，证明很少 在临床上有用。大约20％住院的背痛 患者被诊断为脊柱狭窄。该诊断是基于 假设脊柱神经元素可用的空间不足 可能导致腰部和腿部疼痛。该假设得到了多年的支持 临床经验，但人们普遍认为有很多 例外。脊柱狭窄的诊断通常基于定性 用X射线，CT和/或MRI数据进行的评估。有限的定量 已经描述了指南，但并非广泛使用，部分 因为敏感且特异的狭窄阈值水平 症状从未得到证明。可重复测量脊柱的技术 常见成像方式的狭窄很容易获得。社会会 在获得和使用的准则之后，从这项技术中受益 定量测量已验证。可以验证新的诊断测试 使用代表正面和负面发现的测量值。许多患者 脊柱狭窄在某些位置几乎没有或没有疼痛 其他位置的严重疼痛。这些患者可能会越过阈值 通过改变脊柱的位置来狭窄。这个重要和普遍 临床观察点与可用于验证的强大模型 脊柱狭窄的定量测量，因为ACH患者可以用作 他们自己的控制。拟议研究的具体目的是确定 对脊柱狭窄的特定测量，对 症状，并确定影响影响 脊柱狭窄和背部或腿部疼痛。几种不同的定量 将进行测量以说明许多可能的狭窄类型。 测量将成为非侵入性的三维计算机 脊柱的重建处于痛苦的位置，并与测量 用脊柱制成的位置不那么痛苦。心理社会变量会 还记录了这些变量在 脊柱狭窄与症状之间的关系。这项调查将是 在一个已建立的大型大学脊柱中心进行 临床结果计划，建立了对成像数据的访问，并将使用 经过验证的测量技术。拟议的调查将提供 临床适用的测量指南评估脊柱 狭窄。