The Basic And Clinical Research Of The Correlation Between The Degeneration Of Lumbar Vertebra And Chronic Low Back Pain

[Objectives]:To analyze the correlation between the degeneration of lumbar interveterbral disc, facet joint.the lumbar curvature.the lumbar stability and chronic low back pain.To explore the effect of lumbar stability on the TNF-a espression in lumbar interveterabral disc, ligamenta flava, facet joint. To investigate the effect of lumbar flexibility and facet joint degeneration on the improvement rate after lumbar internal fixation.[Method]:1.80patients with chronic low back pain were enrolled in this prospective study.All suffered from a more than3months low back pain.with or without Lower extremity radicular pain. And all patients have not undergone any lumbar operation, the degeneration of lumbar intervetebral disc and facet joint was graded through CT and MRI imagine. The lumbar stability was measured by lateral X ray imagine at flexion and extension position. And the lumbar curvature was measured too. VAS score was obtained for all patients.2.50patients which underwent lumbar internal fixation were studied.23cases have lumbar instability and the others not.lumbar disc.facet joint, ligamenta flava were havested during opeanion. Immunohistochemistry was used for analysis of TNF-α in lumbar disc, ligamenta flava and facet joint.3. Totally120cases underwent lumbar internal fixation of L4and L5. Lumbar lordosis angle at extension and flexion position was measured preoperatively as the lumbar flexibility index. Facet joint angle of L3,4was measured and the degeneration of facet joint was graded. Oswestry score was obtained before and after one year operation and improvement rate was calculated. The effect of the lumbar flexibility and facet joint degeneration on the improvement rate after operation was analyzed.[Result]:1.The VAS score is different in patients with different lumbar intervertebral disc degeneration grade. Patients with pearce3.4grades have more severe low back pain than pearce1.2grades.The degeneration of facet joint is positively correlated with low back pain. The lumbar cobbe angle and flexibiltiy is decreased in patients with low back pain.and the instability rate is higher.2. The TNF a expression in lumbar intervertebral disc.ligamenta flava and facet joint is higher in patients with lumbar instability.3. Lumbar flexibility was positively correlated with the improvement rate of low back pain. Patients with severe degeneration of the facet joint and with asymmetry facet joint angle both have a bad improvement rate.[Conclusions]:1.The degeneration of lumbar intervertebral disc, facet joint and lumbar vertebral instability are important causes of chronic low back pain.2.The inflammatory response intensity of lumbar intervertebral disc, ligamentum flavum and facet joint is higher in patients with lumbar instability.3. Lumbar flexibility, lumbar facet joint degeneration and facet joint symmetry are the important factors which influence the outcome of lumbar internal fixation.