Z Joint Changes in Low Back Pain Following Adjusting

调整后腰痛的 Z 关节变化

• 批准号: 7793101
• 负责人: Gregory D Cramer
• 金额: $ 9.98万
• 依托单位: NATIONAL UNIVERSITY OF HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-30 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7793101
• 关键词: Acute; Address; Adhesions; Anatomy; Anterior; Appointment; Blinded; Chiropractic manipulation; Clinical; Control Groups; Data Analyses; Dimensions; Grouping; Joints; Low Back Pain; Lumbar Regions; MRI Scans; Magnetic Resonance Imaging; Measurement; Measures; Outcome; Pain; Patients; Perception; Positioning Attribute; Posture; Questionnaires; Randomized; Randomized Controlled Trials; Recruitment Activity; Research Personnel; Scanning; Side; Spinal; Structure; Visual; analog; chiropracty; disability; follow-up; functional disability; healthy volunteer; improved functioning

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.

描述（由申请人提供）：该延续项目（NIH/NCCAM # RO1 AT00123）的目的是使用 MRI 来评估患有急性关节炎的受试者在侧姿势定位和侧姿势脊柱调整后关节突 (Z) 关节的间隙。腰痛（LBP）。脊椎按摩疗法脊柱调整的有益效果之一的基本假设是，由于 Z 关节结构活动性低下而在 Z 关节中产生的粘连，被认为可以通过脊柱调整使 Z 关节分离（间隙）来减轻。在之前的研究中，发现侧姿势调整会导致健康受试者的 Z 关节出现间隙。本研究的目的是确定 112 名急性 LBP 受试者在侧位定位期间和腰椎侧位脊柱调整后是否可以测量 L4/L5 和 L5/S1 Z 关节间隙的差异，并确定是否可以测量 L4/L5 和 L5/S1 Z 关节间隙的差异。间隙的大小与疼痛缓解和功能改善有关。治疗两周后，受试者将暂时随机分为 4 个 MRI 组之一：1）中立位，然后是侧卧位（最疼痛的一侧朝上）； 2）中立位，然后调整侧位（最痛的一侧朝上），然后中立位； 3）中立位，然后调整侧位（最痛的一侧朝上）并保持侧位； 4）（纯对照组）中立位，然后是非常简短的侧姿势定位，然后是中立位。 MRI 扫描将在受试者处于原始中立位置和最终位置时进行。两次 MRI 扫描将在大约 30 分钟内连续进行（每次扫描 12 分 19 秒）。此次预约期间进行的所有脊柱调整将在第一次扫描后直接在 MRI 龙门台上进行。第二次 MRI 预约将在治疗 2 周后 2 周后进行。在第二次 MRI 预约时，受试者将被分配到与第一次 MRI 预约期间随机分配到的 MRI 组相反的 MRI 组。三名观察者（彼此不知情且不了解受试者分组）将直接根据 MRI 扫描对 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相关（从初次检查到 MRI 预约的视觉模拟量表差异）和残疾（伯恩茅斯问卷分数差异）。本研究的结果将用于加深对急性腰痛患者腰椎侧位调整和侧位定位作用机制的了解。