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Lecture, Session1C
08.30-10.30
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Clinical Application of OSMIA
Clinical Applications of Quantitative Fluoroscopy of the Spine
Current evidence relating to chronic, non-specific back and neck pain provides little or no support for them being physical illnesses. Like other conditions with no physiological marker, evidence-based management is therefore generally of a psycho-social nature. Where there is evidence in support of physical interventions such as manipulation and exercise, their mechanisms of action are generally unknown and their effectiveness in individuals unpredictable.
Since most non-specific back and neck pain are aggravated or relieved by movement or position, it makes sense to search the mechanical dimension for a physiological marker. Cadaveric studies of inter-vertebral mechanics allow us to explore the relationships of inter-vertebral mechanical change to structure, but not to symptoms.
Quantitative fluoroscopy is a new technology that allows inter-vertebral motion patterns to be objectively measured in living subjects to probe the intrinsic biomechanics of the spine in chronic, disabling back or neck pain. Much research has been conducted into its development and validation and it is now beginning to come into clinical use at the AECC in the UK, in the US and in Hong Kong.
Otherwise known as an Objective Spinal Motion Imaging Assessment (OSMIA), the investigation measures the stability of the passive holding elements between vertebrae (resting muscle, ligaments and discs). Typical examples are found in patients where back pain repeatedly relapses, or is intolerant to movement, or has not recovered from spine stabilisation surgery, or where stabilisation surgery is being considered. Sixty-four such patients have so far had the investigation in the UK.
This presentation will review the results of a few of these investigations that illustrate how it is currently being used in diagnosis and clinical decision-making for difficult lumbar and cervical conditions.
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