L INSTABILITA VERTEBRALE LOMBARE: NOVITA DALLA LETTERATURA

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1 L INSTABILITA VERTEBRALE LOMBARE: NOVITA DALLA LETTERATURA Luciano Bissolotti Servizio di Recupero e Rieducazione Funzionale Casa di Cura Domus Salutis-Brescia Cenni storici Magnuson P (1944) Causes of pain in the lower back. Ann Surg 119: Barr JS (1950) Editorial back pain. J Bone Joint Surg 32B: Harris R, Mcnab I (1954) Structural changes in the lumbar intervertibral discs their relationship to low back pain and sciatica. J Bone Joint surg 36B: Harmon P (1964) Indications for spinal fusion in lumbar diskopathy, instability and arthrosis indications for spinal fusion in lumbar diskopathy, instability and arthrosis. I. Anatomic and functional pathology and review of literature. Clin Orthop Relat Res 34:

2 PubMed J Spinal Disord Dec;5(4):383-9; discussion 397. The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. Panjabi MM J Spinal Disord Dec;5(4):390-6; discussion 397. The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. Panjabi MM. 2

3 Neutral zone stiffness resistenza 3

4 .. the most commonly cited thresholds for segmental instability were (1) a sagittal-plane translation of at least 3 mm (4mm), or 9% (15%) of the vertebral body width, on either a flexion or extension radiograph, and d(2) a sagittal-plane l rotation ti of greater than 9 (15 ) degrees for the lumbar motion segments between L1 and L5 Test clinici: Passive Lumbar Extension Sensibilità (%) Specifictà (%) A New Evaluation Method for Lumbar Spinal Instability: Passive Lumbar Extension Test. Physical Therapy. Volume 86. Number 12. December 2006 Yuichi Kasai, Koichiro Morishita, Eiji Kawakita, Tetsushi Kondo, Atsumasa Uchida 4

5 instability catch sign test, subjects were asked to bend their bodies forward as much as possible and then return to the erect position; subjects who were not able to return to the erect position because of sudden low back pain were judged to have lumbar spinal instability. Sensibilità (%) Specifictà (%) Sensibilità (%) Specifictà (%) painful catch sign test, subjects were asked to lift both lower legs in the knee extension position and then return their legs slowly to the examination table; subjects whose legs fell down instantly to the examination table because of sudden low back pain were judged to have lumbar spinal instability apprehension sign test test, subjects were asked whether they had felt a sensation of lumbar collapse because of sudden low back pain when they performed ordinary acts, including bending back and forth or from side to side and sitting down or standing up Sensibilità (%) Specifictà (%)

6 .da Medline all ambulatorio. Gruppo IL (n 22) Gruppo LA (n 22) Media/DS Media/DS Età (anni) 61.5± ±3.5 Peso (kg) 73.2± ±20.5 ADL 0.7± ±1.1 IADL 2.5± ±1.8 Test di Adams (cm) 23.2± ±19.1 VAS (0-10) 5.5± ±2.2 ODI1.0 (%) 37.7±15.17± ± RMQ 12.4± ±5.5 % % Famiglia Laseguè Wasserman 9 5 Dolore notturno

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8 Tab.2: variazione dell intensità del dolore (VAS 0-10) durante l esecuzione del test cinematico. Gruppo IL Gruppo LA Lateroflessioni: Lato destro 4.1± ±3.2 Lato sinistro 3.5± ±3.4 Estensione 3.7± ±2.9 Tab.3: variazione della mobilità vertebrale attiva (arom) durante l esecuzione del test cinematico. Gruppo IL Gruppo LA Lateroflessioni (totale): Lato destro ( ) 32.0± ±8.8 Lato sinistro ( ) 35.1± ±9.9 Lateroflessioni (lombare): Lato destro ( ) 80±39 8.0±3.9 99±69 9.9±6.9 Lato sinistro ( ) 9.3± ±5.8 Estensione ( ) 14.5± ±8.6 8

9 Errore medio nel riposizionamento articolare del tratto lombare Gruppo IL Gruppo LA SJR ( ) Bending lat. Estensione Gruppo IL peggiore del 15-20% Raggio al quadrato e area descritta da C7 (mm 2 ) Gruppo IL Gruppo LA r2 * 90% Area 9

10 Test stabilometrico GruppoIL Gruppo LA Occhi aperti Occhi chiusi Occhi aperti Occhi chiusi Distanza talloni (mm) 176.1± ± ± ±47.1 Raggio quadrato (mm 2 ) 53.1± ± ± ± % area C7 (mm 2 ) 354.5± ± ± ±686.2 Lunghezza traiettoria (mm) 163.8± ± ± ±79.4 Velocità traiettoria (mm/sec) 5.6± ± ± ±2.6 Conclusioni Basi biomeccaniche consolidate Test clinici affidabili Strumenti clinometrici validati/affidabili Diagnosi strumentale riabilitativa Migliore raffinatezza nel sub-grouping Definizione di PDT appropriati 10

11 Luciano Bissolotti, MD Casa di Cura Domus Salutis, Brescia, Italy Via Lazzaretto 3, Tel: Web site: 11