Subakut/kronik bel ağrısında lomber faset eklem tropizmi, paraspinal kas yağlı atrofisi, sagittal spinopelvik parametreler arasındaki ilişki
Küçük Resim Yok
Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Tekirdağ Namık Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmada subakut ve kronik dönem bel ağrılı hastalarda Pİ-LL uyumsuzluğu ve Pİ parametresinin, FT ve paraspinal kaslar üzerine etkisini araştırmayı ve bu sayede bel ağrısında etkili olan mekanik faktörlerle ilgili bilgimizi artırmayı amaçladık. Çalışmamız retropektif kesitsel olarak planlandı. Dört hafta ve üzeri non-spesifik bel ağrısı olan, 30-65 yaş arası, toplam 105 hasta çalışmaya dahil edildi. Lateral lomber grafi görüntüleri üzerinden spinopelvik açıları; MRG görüntüleri üzerinden faset tropizm değerleri paraspinal kas yağlı atrofi düzeyleri değerlendirildi. Hastalar Pİ-LL uyumsuzluğuna göre "var- 2 gruba, Pİ derecesine göre 3 gruba ayrılıp her seviyede FT ve paraspinal kas yağlı atrofisi ile ilişkisine bakıldı. Hasta grupları arasında VAS, ODİ, İBAS ölçekleri ve ağrı süresi parametreleri karşılaştırıldı. Ek olarak hastalar L3-4 seviyesi paraspinal kaslarındaki yağlı atrofi düzeylerine göre lomber bölgedeki her seviye için FT varlığı ve derecesi değerlendirildi. Çalışmamızın sonuçlarına göre Pİ-LL uyumsuzluğu olan grupta, uyumsuzluk olmayan gruba göre L4-5 ve L5-S1 seviyelerinde FT varlığı, L5-S1 FT derecesi (7,1 (0,6- 34,5) vs 4,05 (0,1 - 28,7)) ; VAS, ODİ skorları ve ağrı süresi istatistiksel anlamlı olarak daha yüksektir (p<0,05). Pİ açı derecesi ile FT varlığı, derecesi, bel ağrısı süresi ve ölçek skorları arasında istatistiksel olarak anlamlı bir ilişki yoktur (p>0,05). Pİ-LL uyumsuzluğu ile paraspinal kas yağlı atrofi dereceleri incelendiğinde L2-3 MF kası için, Pİ-LL uyumsuzluğu olanlarda (1,39 ± 0,63) yağlı atrofi derecesi uyumsuzluk olmayanlara (1,13 ± 0,62) göre istatiksel anlamlı olarak daha fazladır (p=0,039). Pİ derecesine göre paraspinal kas yağlı atrofi derecesi incelendiğinde Pİ derecesi "azalmış" grup diğer gruplardan farklılık göstermiştir ve bu grupta yağlı atrofi derecesi istatiksel anlamlı düzeyde daha fazladır (p=0,005). L3-4 seviyesi paraspinal kasları yağlı atrofisine göre göre FT incelendiğinde; PM kası için, OŞ grupta HO gruba göre L1-2 FT varlığı istatistiksel anlamlı düzeyde daha fazladır (p=0,006). Aynı kas için L4-5 FT varlığı, OŞ grupta belirgin olarak artmış ise de istatistiksel anlamlılığa ulaşmamıştır (p=0,076). FT açı değerlerine bakıldığında ise L4-5 FT derecesi OŞ grupta (9,9 (0,2 - 23,3)), HO grubuna (5,75 (0 - 26,3)) göre istatiksel anlamlı düzeyde daha yüksektir (p=0,042). L1-2 FT derecesi ise OŞ grupta (7,3 (0,4- 19,1)) HO gruba (4 (0,1- 17,3)) göre yüksek olsa da istatiksel anlamlı boyuta ulaşmamıştır (p=0,051). L3-4 ES kası yağlı atrofi grubuna göre, L1-2 FT derecesi OŞ grupta (5,1 (0,4- 19,1)) HO gruba (3,7 (0,1- 14,5)) göre yüksek olsa da istatiksel anlamlılığa ulaşmamıştır (p=0,053). Aynı kas için diğer seviyelerde FT varlığı ve FT dereceleri arasında istatistiksel olarak anlamlı bir bağlantı yoktur (p>0,05). L3-4 MF kası yağlı atrofi grubuna göre , L1-2 FT varlığı OŞ grupta HO gruba göre istatiksel anlamlı düzeyde daha fazladır (p=0,02). Aynı kas için FT derecesi değerlendirildiğinde L1-2 FT dercesi OŞ grupta (5,9 (0,1- 19,1)) HO gruba (3,5 (0,3- 14,5)) göre istatistiksel anlamlı düzeyde daha yüksektir (p=0,009). Pİ açı derecesi ve Pİ-LL uyumsuzluğu hem lomber omurga mekaniğinde etkili diğer lomber yapılar hem de bel ağrısıyla ilişkili olabilir. Bu ilişkinin segment spesifik yorumlanması ve bel ağrısındaki klinik öneminin net olarak belirlenmesi için kontrol grubunun dahil ediliği, daha yüksek hasta sayısı ile yapılan çalışmalara ihtiyaç vardır.
In this study, we aimed to investigate the effect of PI-LL mismatch and PI parameter on FT and paraspinal muscles in patients with subacute and chronic low back pain and thus to increase our knowledge about the mechanical factors that are effective in low back pain. Our study was planned as a retrospective cross-sectional study. A total of 105 patients aged 30-65 years with non-specific low back pain for four weeks or more were included in the study. Spinopelvic angles were evaluated on lateral lumbar radiographs and facet tropism values and paraspinal muscle fatty atrophy levels were evaluated on MRI images. Patients were divided into 2 groups according to PI-LL discordance and 3 groups according to the degree of PI and the relationship between FT at each level and paraspinal muscle fatty atrophy was evaluated. VAS, ODI, IBAS scales and pain duration parameters were compared between patient groups. In addition, the presence and degree of FT were evaluated for each level in the lumbar region according to the fatty atrophy group( NM; non to modarate , MS; modarete to sever) in the paraspinal muscles at the L3-4 level. According to the results of our study, the presence of FT at L4-5 and L5-S1 levels, L5-S1 FT grade (7.1 (0.6- 34.5) vs 4.05 (0.1- 28.7)), VAS, ODI scores and pain duration were statistically significantly higher in the group with PI-LL mismatch compared to the group without mismatch (p<0.05). There was no statistically significant relationship between the degree of PI angle and the presence and degree of FT, duration of low back pain and scale scores (p>0.05). When the degree of paraspinal muscle fatty atrophy was analyzed with PI-LL mismatch, the degree of fatty atrophy in those with PI-LL mismatch (1.39 ± 0.63) was statistically significantly higher than those without mismatch (1.13 ± 0.62) for L2-3 MF muscle (p=0.039). When the degree of paraspinal muscle fatty atrophy was analyzed according to the degree of PI, the group with "decreased" degree of PI differed from the other groups and the degree of fatty atrophy was statistically significantly higher in this group (p=0.005). When FT was analyzed according to fatty atrophy of the paraspinal muscles at the L3-4 level; for the PM muscle, the presence of L1-2 FT was statistically significantly higher in the group than in the NM group (p=0,006). For the same muscle, the presence of L4-5 FT was significantly increased in the MS group, but did not reach statistical significance (p=0.076). In terms of FT angle values, the degree of L4-5 FT was statistically significantly higher in the MS group (9.9 (0.2 - 23.3)) compared to the NM group (5.75 (0 - 26.3)) (p=0.042). The degree of L1-2 FT was higher in the MS group (7.3 (0.4- 19.1)) than in the NM group (4 (0.1 - 17.3)), but did not reach statistical significance (p=0.051). Compared to the fatty atrophy groups in the L3-4 ES muscle, the L1-2 FT grade was higher in the MS group (5.1 (0.4- 19.1)) than in the NM group (3.7 (0.1- 14.5)) but did not reach statistical significance (p=0.053). For the same muscle, there was no statistically significant correlation between the presence of FT at other levels and the degree of FT (p>0.05). Compared to the fatty atrophy groups in the L3-4 MF muscle, the presence of FT at L1-2 was statistically significantly higher in the MS group than in the NM group (p=0.02). When the degree of FT for the same muscle was evaluated, the degree of L1-2 FT was statistically significantly higher in the MS group (5.9 (0.1- 19.1)) than in the NM group (3.5 (0.3- 14.5)) (p=0.009). The degree of PI angle and PI-LL mismatch may be related to both other lumbar structures that are effective in lumbar spine mechanics and low back pain. For a segment-specific interpretation of this relationship and a clear determination of its clinical significance in low back pain, studies with a larger number of patients and a control group are needed.
In this study, we aimed to investigate the effect of PI-LL mismatch and PI parameter on FT and paraspinal muscles in patients with subacute and chronic low back pain and thus to increase our knowledge about the mechanical factors that are effective in low back pain. Our study was planned as a retrospective cross-sectional study. A total of 105 patients aged 30-65 years with non-specific low back pain for four weeks or more were included in the study. Spinopelvic angles were evaluated on lateral lumbar radiographs and facet tropism values and paraspinal muscle fatty atrophy levels were evaluated on MRI images. Patients were divided into 2 groups according to PI-LL discordance and 3 groups according to the degree of PI and the relationship between FT at each level and paraspinal muscle fatty atrophy was evaluated. VAS, ODI, IBAS scales and pain duration parameters were compared between patient groups. In addition, the presence and degree of FT were evaluated for each level in the lumbar region according to the fatty atrophy group( NM; non to modarate , MS; modarete to sever) in the paraspinal muscles at the L3-4 level. According to the results of our study, the presence of FT at L4-5 and L5-S1 levels, L5-S1 FT grade (7.1 (0.6- 34.5) vs 4.05 (0.1- 28.7)), VAS, ODI scores and pain duration were statistically significantly higher in the group with PI-LL mismatch compared to the group without mismatch (p<0.05). There was no statistically significant relationship between the degree of PI angle and the presence and degree of FT, duration of low back pain and scale scores (p>0.05). When the degree of paraspinal muscle fatty atrophy was analyzed with PI-LL mismatch, the degree of fatty atrophy in those with PI-LL mismatch (1.39 ± 0.63) was statistically significantly higher than those without mismatch (1.13 ± 0.62) for L2-3 MF muscle (p=0.039). When the degree of paraspinal muscle fatty atrophy was analyzed according to the degree of PI, the group with "decreased" degree of PI differed from the other groups and the degree of fatty atrophy was statistically significantly higher in this group (p=0.005). When FT was analyzed according to fatty atrophy of the paraspinal muscles at the L3-4 level; for the PM muscle, the presence of L1-2 FT was statistically significantly higher in the group than in the NM group (p=0,006). For the same muscle, the presence of L4-5 FT was significantly increased in the MS group, but did not reach statistical significance (p=0.076). In terms of FT angle values, the degree of L4-5 FT was statistically significantly higher in the MS group (9.9 (0.2 - 23.3)) compared to the NM group (5.75 (0 - 26.3)) (p=0.042). The degree of L1-2 FT was higher in the MS group (7.3 (0.4- 19.1)) than in the NM group (4 (0.1 - 17.3)), but did not reach statistical significance (p=0.051). Compared to the fatty atrophy groups in the L3-4 ES muscle, the L1-2 FT grade was higher in the MS group (5.1 (0.4- 19.1)) than in the NM group (3.7 (0.1- 14.5)) but did not reach statistical significance (p=0.053). For the same muscle, there was no statistically significant correlation between the presence of FT at other levels and the degree of FT (p>0.05). Compared to the fatty atrophy groups in the L3-4 MF muscle, the presence of FT at L1-2 was statistically significantly higher in the MS group than in the NM group (p=0.02). When the degree of FT for the same muscle was evaluated, the degree of L1-2 FT was statistically significantly higher in the MS group (5.9 (0.1- 19.1)) than in the NM group (3.5 (0.3- 14.5)) (p=0.009). The degree of PI angle and PI-LL mismatch may be related to both other lumbar structures that are effective in lumbar spine mechanics and low back pain. For a segment-specific interpretation of this relationship and a clear determination of its clinical significance in low back pain, studies with a larger number of patients and a control group are needed.
Açıklama
Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Ana Bilim Dalı, Fiziksel Tıp ve Rehabilitasyon Bilim Dalı
Anahtar Kelimeler
Fiziksel Tıp ve Rehabilitasyon, Physical Medicine and Rehabilitation
