Abstract
Degenerative lumbar spondylolisthesis (DLS) causes the development of sagittal spinal-pelvic imbalance with accompanying muscle imbalance in lumbar-pelvic area which is not able to be eliminated spontaneously and worsens the functional results of conservative and surgical treatment. Objective: To develop a method of correcting selective kinesiotherapy (KSP) for the patients with DLS for correction of muscle imbalance and to test it in long-term period after instrumented lumbar spine fusion. Methods: We used clinical, radiological (with radiometry), biomechanical (including computerized electromechanical goniometry), and statistical methods. As material we applied surveys from 10 men with LIV DLS aged from 46 to 65 years (prior to surgery, after 3 and 6 months, 1 year) which were randomly divided into groups: Vosn — we used a new technique of KSC (pat. 83739, Ukraine), Vkontr — we used a standard program of postisometric relaxation. Results: In all patients in the preoperative period we found degenerative deformity «flat back», infringement of kinematics of the spine and myofixation of the torso, moderate pain intensity according to VAS and high indexes of disabilitation according to Oswestry scale, kineziofobia according to Tampa scale, dismay and anxiety related to the expectation of pain, and according to PASS scale. Despite on surgical correction of sagittal spinal contour there were not detected any significant decreasing of indexes of disabilitation, elimination of myotonic reactions and muscle imbalances in lumbar-pelvic area. In the closest terms of using of KSC technique there also were no any significant differences between the studied groups of patients in none of the clinical signs. We traced a tendency to improvement in endurance of extensor and flexor muscles of the spine, pelvis and hips, PASS, VAS and ODI indexes in the Vosn group. Conclusion: There were proven an efficiency and an opportunity of using a developed KSC technique at all stages of rehabilitation in patients with degenerative spinal deformities and muscle imbalance.
Highlights
In cases of lumbar osteochondrosis degenerative spinal deformities and joined with them sagittal spinal-pelvic imbalance accompanied by an imbalance of the muscles of the lumbar-pelvic area which might not be eliminated spontaneously and worsens functional outcome of conservative and surgical treatment
We observed pain of high intensity according to VAS and high indexes of dyzabilitation Oswestry, kineziofoby according to Tampa scale, and anxiety and worry related to the expectation of pain according to PASS scale
Nearest results of the application of the developed technique of selective corrective kinesiotherapy has demonstrated its effectiveness through established significant reduction in pain intensity according to VAS, improvement of indexes of disabilitation and functional status of muscles lumbarpelvic area after izokinetic tests on endurance, increasing of spinal segments excursion
Summary
Материалом исследования послужили протоколы клинико-рентгенологического обследования 42 пациентов мужского пола в возрасте 20–40 лет (средний возраст (33,4 ± 4,8) года) с поясничным остеохондрозом до операции, через 3 и 6 мес., год и более после хирургического лечения со средним сроком наблюдения (1,2 ± 0,8) года. Новая методика селективной кинезиотерапии для коррекции мышечного дисбаланса при различных вариантах сагиттального позвоночно-тазового дисбаланса (патент Украины на полезную модель No 83739 [1]) применялась в подгруппе Аосн. В подгруппе Аконтр использовали стандартную программу постизометрической релаксации мышц поясничного отдела позвоночника при поясничном гиполордозе. После хирургического лечения измеряли величину позвоночного (поясничный лордоз GLL) и тазового (наклон крестца SS) параметров сагиттального позвоночно-тазового баланса по методике J. Выбор наклона крестца SS в качестве изучаемого тазового параметра обусловлен тем, что в исследованиях последних лет именно позиция крестца определяет центрирование сегментов тела, являясь ключевой в позвоночно-тазовом балансе и составляя «неискажаемую часть» изгибов позвоночника [17]. В биомеханических исследованиях на платформенном статографе в статическом положении при удобном стоянии определяли положение проекции общего центра масс (ОЦМ) на площадь опоры в сагиттальной (ОЦМY) и фронтальной (ОЦМХ) плоскостях. При статистических исследованиях определяли медиану с величиной стандартного отклонения, t-критерий по методу Стьюдента с уровнем значимости р < 0,05, проводили корреляционный анализ по Пирсону
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