Document Detail

MRI evaluation of lumbar spine flexion and extension in asymptomatic individuals.
MedLine Citation:
PMID:  11034886     Owner:  NLM     Status:  MEDLINE    
Flexion and extension movements or positions have been advocated in the treatment of various forms of low back dysfunction due to the potential pain relieving effects attributed to displacements of the intervertebral disc (IVD). Objective in vivo determination of the segmental behaviour of the disc to contrasting positions has until recently been difficult. Magnetic resonance imaging (MRI) was used in this study to evaluate the influence of sagittal plane positions on lumbar IVD height and nucleus displacement in a small asymptomatic population.T2-weighted sagittal plane images from L1 to S1 were obtained from 10 subjects (mean age: 30+/-5 years) positioned supine in lumbar flexion, followed by extension. Changes in disc height and localization of nucleus position (determined by peak MRI signal intensity) between the two positions were calculated. Discs were classified for degenerative changes using a semi-quantitative grading scale. The mean range of lumbar sagittal movement achieved in the MRI was 44 degrees (range: 22-77 degrees ). Between flexion and extension, a significant increase in measured anterior disc height of 1.1 mm (P<0.0001) and anterior displacement of the nucleus of 6.7% (P<0.0001) was observed. Despite the anterior displacement of the nucleus in extension observed in the pooled analysis, 30% of discs did not follow this trend. Nucleus degeneration was observed in at least one disc in nine subjects and in 26% of all discs examined. Lumbar spine position was found to be associated with small measured changes in anterior disc height and nucleus position, however, this response was variable within and between individuals. The theoretical concept of a stereotypical effect of spinal position on the lumbar IVD is challenged by these initial data. Since the health of the disc is often unknown in clinical practice, manual therapy treatment for lumbar spine pain should be based on the symptomatic response to movement and position rather than biomechanical theory.
S J Edmondston; S Song; R V Bricknell; P A Davies; K Fersum; P Humphries; D Wickenden; K P Singer
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Manual therapy     Volume:  5     ISSN:  1356-689X     ISO Abbreviation:  Man Ther     Publication Date:  2000 Aug 
Date Detail:
Created Date:  2000-10-27     Completed Date:  2000-11-13     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  9610924     Medline TA:  Man Ther     Country:  SCOTLAND    
Other Details:
Languages:  eng     Pagination:  158-64     Citation Subset:  IM    
Copyright Information:
Copyright 2000 Harcourt Publishers Ltd.
Centre for Musculoskeletal Studies, University of Western Australia, Perth, 6000.
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MeSH Terms
Analysis of Variance
Image Interpretation, Computer-Assisted / methods*
Intervertebral Disk Displacement / diagnosis*
Low Back Pain / diagnosis*
Lumbar Vertebrae / pathology*
Magnetic Resonance Imaging / instrumentation,  methods*
Range of Motion, Articular
Reproducibility of Results

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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