The Study Of The Change Of Multifidus Muscle By Four-Dimensional Traction Therapy In Degenerative Lumbar Spinal Stenosis

Background: Degenerative lumbar spinal stenosis(DLSS)is a common spinal disease,which seriously affects the daily life and work of the middle-aged and the elderly.The main causes of stenosis are oppression coming from the hyperosteogeny and soft tissue.At present,the principle of treating DLSS is to enlarge the volume of spinal canal and relieve nerve compression.There are some conservative treatments that could improve the symptoms including drugs,physiotherapy,acupuncture.However,the really effect is difficult to determine for long-term follow-up.In western medicine,surgical decompression or combine lumbar interbody fusion(LIF)can relieve the symptoms quickly.However,the operation just deal with local problem,lacking in understanding of the concept of wholism of the spine.So,it is difficult to solve the problem fundamentally.In recent years,the famous Chinese chiropractor Professor Wei has invented four-dimensional traction(FDT)therapy based on the theory of suspension reduction in ancient China.The spinal sequence can be adjusted and the normal lumbar spinal curvature can be restored by mobilizing both sides of the psoas major.Then the volume and the size of the intervertebral foramen will be extended.Finally,improving the symptoms of low back pain and nerve root stimulation.Multifidus muscle(MM)as the central core muscle group of the lumbar spine plays an important role in maintaining the stability of the lumbar spine.Currently,few clinical studies related to MM were be reported.Based on this situation,our study was to observe the changes of MM in DLSS patients by the FDT therapy.Objectives:This study aims at the change of multifidus cross-sectional area(CSA)and fatty infiltration(FI)in DLSS by the FDT treatment.Exploring the mechanism of MM in DLSS and analyzing the internal relations between FDT with lumbar MM.To help the Chinese chiropractic medicine achieve greater application in clinic.Objectives:Method: According to the diagnostic and inclusion criteria of DLSS,sixty hospitalized patients were selected in this study in Fangcun Department of Orthopedics,Guangdong Province Hospital of Chinese Medical.They were divided into test group(FDT and muscle exercise)and control group(muscle exercise)under the role of randomized control.Lumbar JOA score and VAS score as the clinical index were recorded at before treatment,one week after discharge and one month after discharge.The multifidus total crosssectional area(TCSA),function cross-sectional area(FCSA)and FI were measured by L4-L5 segment T2 weighted magnetic resonance imaging at before treatment and one month after discharge.To evaluate the clinical efficacy and safety of FDT,and to discuss the mutual relationship among the DLSS,FDT and MM.Statistical calculation of the study used SPSS 22.0 Analysis software.Independent sample t test was applied to compared with average of two groups’ data;Paired sample t test was applied to compared with average of the data of before and after treatment in same group;Variance analysis was applied to compared with average of three sets of data.Results: In terms of clinical efficacy,the JOA score and VAS score were significantly improved comparing before treatment to one week after discharge and one mouth after discharge,the difference was statistically significant(P<0.05);There were significant differences of JOA score between two groups were found(P<0.05);However,there were no differences of VAS score between two groups were found(P>0.05).In terms of imaging,there was no significant difference in multifidus TCSA and FCSA between two groups and between two sides(all P>0.05).And the FI of left and right sides of MM in two groups shown the statistically significant,P<0.05.There were no significant difference of multifidus TCSA in two groups between before treatment and one month after discharge.However,the multifidus FCSA increased and FI decreased comparing the before treatment,the difference was statistically significant(P<0.05).Compared to the control group,the multifidus TCSA of test group has no obvious improvement without statistical significance(P>0.05),but the multifidus FCSA and FI has changed,the difference was statistically significant(all P<0.05).In terms of correlation,there was no significant different between the changes of multiple muscle and the JOA score in two groups after treatment(P>0.05).Conclusion: Two groups’ treatment methods all can obviously improve the clinical symptoms in DLSS.There were differences in fat infiltration between the left and right sides of the multifidus muscle in two groups before treatment,which indicating some reasons,such as the affected side,the course of disease,and the situation of stenosis.Multiple factors study can be the further study.Four dimensional traction can improve the function of lumbar vertebra and improve degenerative condition of muscles in DLSS,but the mechanism of change of multifidus muscle need to be further explored.There is no correlation between the improvement of MM and the JOA score in this study,which may be related insufficient intervention time or the selection of indicators.