Esta pesquisa teve como principal objetivo, validar o teste de flexibilidade da coluna lombar (Testprop), utilizando-se da radiografia como teste critério e o teste flexibilidade da coluna lombar de ADRICHEM e KORST (1973) para o sexo feminino e masculino. Participaram 19 mulheres (média de idade= 23,2 anos e desvio padrão= 1,3) e 18 homens (média de idade= 22,3 anos e desvio padrão= 1,4), universitários, saudáveis e ativos do Curso de Educação Física e Ciências do Esporte da Universidade Estadual de Londrina - PR. Inicialmente, verificou-se a fidedignidade e objetividade dos testes de flexibilidade da coluna lombar (Testprop e Testeips). O coeficiente de correlação intraclasse mostrou que o teste de flexibilidade Testprop apresenta fidedignidade elevada para o sexo feminino (R= 0,86) e elevada para o sexo masculino (R=0,85), e demonstrou haver objetividade moderada (R= 0,73) para o sexo feminino e elevada (R= 0,96) para o sexo masculino. Quanto ao teste de flexibilidade Testeips, a fidedignidade foi elevada (R= 0,85) e (R= 0,86) para o sexo feminino e masculino, respectivamente. A objetividade do teste de flexibilidade Testeips foi moderada (R= 0,62) para o sexo feminino e elevada para o sexo masculino (R= 0,91). Em relação à validade, o coeficiente de correlação de Pearson mostrou correlação baixa para o teste de flexibilidade Testprop (r= 0,11) para o sexo feminino e correlação moderada (r= 0,52) para o sexo masculino. No que diz respeito ao teste de flexibilidade Testeips, o coeficiente de correlação de Pearson foi baixo para o sexo feminino (r= 0,24) e moderado para o sexo masculino (r= 0,50). Concluiu-se que os testes de flexibilidade da coluna lombar Testprop e Testeips foram fidedignos e objetivos, mas não foram considerados válidos. / The main goal was to validate the flexibility test for the lumbar spine (Testprop), using x-ray as a criteria and the flexibility test of the lumbar spine designed by ADRICHEM and KORST (1973) for females and males, 19 women participated (mean age= 23,2 years old; standard deviation= 1,3 year old) and 18 men (mean= 22,3 year old and standard deviation = 1,4) healthy and active students from the Physical Education and Sport Science Course at the Universidade Estadual de Londrina-PR. Initially, it was verified reliability and objectivity (Testprop and Testeips) the lumbar spine flexibility. The intraclass correlation coefficient showed that the reliability of test of flexibility Testprop was high for woman (R= 0.86) and high for men (R= 0.85), there was a moderate objectivity (R= 0.73) for women and high (R= 0.96) for men. Concerning the flexibility test Testeips, the reliability was high (R= 0.85) and (R= 0.86) for woman and men, respectively. The objectivity for the flexibility test Testeips was moderate (R= 0.62) for women and high for men (R= 0.91). Concerning the validity, Pearson correlation coeficient demonstrated a low correlation for the flexibility test Testprop (r= 0.11) for women and moderate for men (r= 0.52). About the flexibility test, Testeips, Pearson correlation coefficient was low for woman (r= 0.24) and moderate for men (r= 0.50). It was concluded that the flexibility tests of the lumbar spine Testprop and Testeips were reliable and objective, but they were not considered valid.

As alterações de sinal no osso subcondral dos corpos vertebrais foram descritas primeiramente por Modic, correlacionando o espectro das alterações da medula óssea no corpo vertebral relacionadas a discopatias degenerativas. O Modic tipo I representa a alteração de sinal do tipo edema, já o Modic II representa a alteração de sinal com padrão de lipossubstituição e o Modic III representa alteração de sinal relacionada a esclerose óssea. O objetivo primário deste estudo foi avaliar se há alteração na detecção dos padrões da classificação Modic na coluna lombar comparando a técnica Dixon com o protocolo tradicional. Como objetivo secundário avaliamos a correlação intra-observador e interobservador. O estudo foi realizado de forma retrospectiva com a inclusão de pacientes cujas ressonâncias magnéticas (RM) foram realizadas na Central de Diagnóstico Ribeirão Preto (CEDIRP). Dois médicos radiologistas de forma independente classificaram as alterações do tipo Modic permitindo uma avaliação interobservador e um dos radiologistas realizou uma segunda análise dos exames possibilitando uma avaliação intra-observador. Os resultados evidenciaram que a técnica Dixon apresentou superioridade na detecção do Modic I em todas as análises e também apresentou médias mais altas da espessura das alterações no osso subcondral. Houve correlações intra-observador moderadas e substanciais no protocolo tradicional e substanciais a altas com a técnica Dixon. A correlação interobservador demonstrou uma correlação moderada na avaliação deste tipo de alteração nos platôs superior e inferior de L3 e correlação inversa e não significativa para a o platô superior de L5 utilizando o protocolo tradicional. Já a correlação interobservador com a técnica Dixon evidenciou concordância perfeita entre os observadores na avaliação de tipo de alteração de sinal no osso subcondral do platô inferior de L1, correlação inversa para o platô inferior de L3 e superior de L4, correlação substancial entre o platô inferior de L2, platô inferior de L5 e superior de L5. Concluímos que a técnica Dixon apresentou superioridade na detecção do Modic I em relação ao protocolo tradicional, assim como permitiu detectar médias mais altas da espessura das alterações no osso subcondral. Também conclui-se que houve boa reprodutibilidade intra-observador e correlação interobservador variável entre os platôs vertebrais analisados / Signal changes in the subchondral bone of the vertebral bodies were first described by Modic, correlating the spectrum of bone marrow changes in the vertebral body to degenerative disc diseases. Modic type I represents the change of edema type signal, while Modic II represents the change of signal with liposubstitution pattern and Modic III represents signal change related to bone sclerosis. The main objective of this study was to evaluate if there is difference in the detection of Modic classification in the lumbar spine comparing the Dixon technique with the traditional protocol. We evaluated the intraobserver and interobserver correlation as a secondary objective. The study was performed retrospectively, including patients whose magnetic resonance imaging (MRI) was performed at the Ribeirão Preto Diagnostic Center (CEDIRP). Two radiologist physicians independently classified the Modic type endplate changes allowing an interobserver evaluation and one of the radiologists performed a second analysis of the exams making possible an intraobserver evaluation. The results showed that the Dixon technique presented superiority in the detection of Modic I in all the analyzes and also presented higher averages of the thickness of the alterations in the subchondral bone. There were moderate and substantial intraobserver correlations in the traditional protocol and substantial to high Dixon technique. The interobserver correlation was moderate in the evaluation of this type of alteration for the upper and lower plateau of L3 and inverse and nonsignificant for the upper plateau of L5 using the traditional protocol. On the other hand, the interobserver correlation with the Dixon technique showed perfect agreement among the observers in the evaluation of type of signal change in the subchondral bone of the lower plateau of L1, an inverse correlation for the lower plateau of L3 and higher of L4, a substantial correlation between the lower plateau of L2, lower of L5 and higher of L5. We conclude that the Dixon technique presented superiority in the detection of Modic I compared with the traditional protocol, as well as allowed the detection higher averages of the thickness of alterations in the subchondral bone. It was also concluded that there was good intraobserver reproducibility and a variable interobserver correlation between the vertebral plateaus analyzed

Among several work-related injuries, low back disorders (LBDs) are the leading cause of lost workdays, and with annual treatment costs in excess of $10 billion in the US. Epidemiological evidence has indicated that prolonged and/or repetitive non-neutral postures, such as trunk flexion, are commonly associated with an increased risk of LBDs. Trunk flexion can result in viscoelastic deformations of soft tissues and subsequent mechanical and neuromuscular alterations of the trunk, and may thereby increase LBD risk. While viscoelastic behaviors of isolated spinal motion segments and muscles have been extensively investigated, in vivo viscoelastic responses of the trunk have not, particularly in response to flexion exposures. Further, most biomechanical efforts at understanding occupational LBDS have not considered the influence of flexion exposures on spine loads. Four studies were completed to characterize viscoelastic deformation of the trunk in response several flexion exposures and to develop and evaluate a computational model of the human trunk that accounts for time-dependent characteristics of soft tissues. Participants were exposed to prolonged flexion at different trunk angles and external moments, and repetitive trunk flexion with different external moments and flexion rates. Viscoelastic properties were quantified using laboratory experiments and viscoelastic models. A multi-segment model of the upper body was developed and evaluated, and then used to estimate muscle forces and spine loads during simulated lifting tasks before and after prolonged trunk flexion at a constant angle and constant external moment. Material properties from the earlier experiments were used to evaluate/calibrate the model. Experimental results indicated important effects of flexion angle, external moment, and flexion rate on trunk viscoelastic behaviors. Material properties from fitted Kelvin-solid models differed with flexion angle and external moment. Nonlinear viscoelastic behavior of the trunk tissues was evident, and predictive performance was enhanced using Kelvin-solid models with ≥2 iii retardation/relaxation time constants. Predictions using the multi-segment model suggested increases in spine loads following prolonged flexion exposures, primarily as a consequence of additional muscle activity. As a whole, these results help to characterize the effects of trunk flexion exposures on trunk biomechanics, contribute to more effective estimates of load distribution among passive and active components, enhance our understanding of LBD etiology, and may facilitate future controls/interventions. / Ph. D.

Rates of lumbar fusion surgery have been increasing with an estimated 192,000 procedures performed annually. However, satisfactory outcomes of lumbar fusion vary considerably and often emphasize technical success, such as arthrodesis, rather than Ill functional and quality of life outcomes. Interbody cage fusion was recently developed and touted as a superior alternative to existing lumbar fusion procedures. There is, however, a paucity of research to support these claims, particularly with regards to functional and quality of life outcomes. Moreover, predictive correlates of outcomes for interbody cage fusion have not been given adequate attention in the literature. The aims of this study were to characterize patients undergoing this new procedure, examine functional and multidimensional outcomes, and investigate the predictive efficacy of presurgical variables. A retrospective cohort research design was employed and entailed medical record reviews for presurgical data and telephone outcome surveys at least 18 months following surgery. Seventy-three patients who had undergone lumbar interbody cage fusion were identified from the private practice of an orthopedic surgeon and the Workers' Compensation Fund of Utah. Presurgical variables coded for analysis included age at the time of surgery, severity rating of presurgical spinal pathology, smoking tobacco, depression, and pursuing litigation at the time of surgery. Of the total sample, 56 patients (76.7%) completed outcome surveys that assessed patient satisfaction, back-specific functioning, disability status, and physical and mental health functioning. While arthrodesis was achieved for most patients (84%), almost half were dissatisfied with their current back condition. Outcomes regarding disability and functioning were mixed. Arthrodesis was only moderately associated with better outcome and for a quite limited set of measure s. Three of the five presurgical variables (tobacco use, depression, and litigation) were consistently predictive of patient outcomes. Findings are discussed and compared to existing data on lumbar fusion procedures , and clinical implications for improved patient selection and possible interventions are highlighted. Consideration is given to the limitations of this study, such as retrospective design, no matched controls , and sample size. Directions for future research are suggested.

The human lumbar spine has been shown to support compressive loads of 1000 N in standing and walking, and up to many thousands of Newtons in strenuous activities such as lifting. The literature presents a number of biomechanical models that seek to replicate the load-carrying capacity of the spine while adhering to physiological constraints. While many of these models provide invaluable insights into the mechanisms governing spinal stability, there is a nearly universal disregard for the magnitude of the muscle forces required in the neutral standing posture. In compliance with constraints on metabolic cost and muscle fatigue, muscle activations in excess of 5% maximum voluntary contraction (MVC) in the standing posture are physiologically infeasible. The purpose of this thesis was to investigate the hypothesis that the passive structures of the lumbar spine are sufficient to produce static equilibrium under the body weight load in the neutral standing posture. A novel method of applying physiologic loads to the lumbar spine in vitro to determine its passive stability was developed. Five cadaver specimens were tested and a passive equilibrium posture was discovered for each. Further, the parameters defining the equilibrium posture correlate well with the standing posture as reported in the literature. This is an indication that the lumbar spine is inherently capable of remaining erect in the neutral posture with muscle activations below 5% MVC. It is postulated that the iliolumbar ligament and the thoracolumbar fascia, passive components that are not typically incorporated into stability models of the spine, have the potential to provide added passive stabilization to the system. It is recommended that biomechanical models of the spine incorporate this 5% MVC constraint and place greater emphasis on the contributions of passive structures to overall stability.

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The effectiveness of exercise has been increasingly studied as exercise has been popular for the improvement of physical performance and rehabilitation of lumbar spine. A variety of exercises have been used to reduce back pain or spinal degeneration. However, there are no studies to determine effects of exercise on lumbar spine kinematics, including lumbar-pelvic coordination and instantaneous axis of rotation. The current study aimed to examine these lumbar spine kinematical changes due to exercise and therapy. We hypothesized that exercise and therapy will affect the changes of lumbar spine kinematics. Lumbar-Pelvic motions were recorded from 86 healthy subjects while performing lifting and lowering tasks of 10% and 25% of body weight. The influence of exercise was quantified from coefficients of curve-fitting for pelvic and lumbar angles. There was a significant difference (p<0.05) for the range of lumbar motion (distribution, D) between the control group and the cardiovascular exercise group after 12-week program. However, there was no significance for lumbar-pelvic coordination, C. A second study was performed to investigate the changes of instantaneous axis of rotation (IAR) at which trunk angle reached 25º. Results indicated that a superior-inferior location of IAR was significantly (p<0.05) modified by the cardiovascular exercise after 12 weeks, but there was no significant effectiveness of the physical therapy exercise. Finding of lumbar spine kinematics during lifting and lowering a weight which are the most popular manual handling activities may provide great understanding of the exercise effectiveness. Future studies are recommended to assess whether the changes of lumbar spine kinematics lead to the decrease instances of lumbar spine injuries or low back pain. / Master of Science

京都大学 / 新制・課程博士 / 博士(医学) / 甲第25155号 / 医博第5041号 / 新制||医||1070(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 今中 雄一, 教授 山本 洋介, 教授 永井 洋士 / 学位規則第4条第1項該当 / Doctor of Agricultural Science / Kyoto University / DGAM