Abstract
PurposeIntervertebral kinematic assessments have been used to investigate mechanical causes when back pain is resistant to treatment, and recent studies have identified intervertebral motion markers that discriminate patients from controls. However, such patients are a heterogeneous group, some of whom have structural disruption, but the effects of this on intervertebral kinematics are unknown.MethodsThirty-seven patients with treatment-resistant back pain referred for quantitative fluoroscopy were matched to an equal number of pain-free controls for age and sex. All received passive recumbent flexion assessments for intervertebral motion sharing inequality (MSI), variability (MSV), laxity and translation. Comparisons were made between patient subgroups, between patients and controls and against normative levels from a separate group of controls.ResultsEleven patients had had surgical or interventional procedures, and ten had spondylolisthesis or pars defects. Sixteen had no disruption. Patients had significantly higher median MSI values (0.30) than controls (0.27, p = 0.010), but not MSV (patients 0.08 vs controls 0.08, p = 0.791). Patients who received invasive procedures had higher median MSI values (0.37) than those with bony defects (0.30, p = 0.018) or no disruption (0.28, p = 0.0007). Laxity and translation above reference limits were not more prevalent in patients.ConclusionPatients with treatment-resistant nonspecific back pain have greater MSI values than controls, especially if the former have received spinal surgery. However, excessive laxity, translation and MSV are not more prevalent in these patients. Thus, MSI should be investigated as a pain mechanism and for its possible value as a prognostic factor and/or target for treatment in larger patient populations.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.
Highlights
Nonspecific low back pain that persists and is unresponsive to treatment (CNSLBP) constitutes the largest part of the health and socioeconomic impact of this problem [1]
While important advances have been made in explaining the mechanisms involved in central pain modulation in chronic nonspecific low back pain (CNSLBP) patients, there have been few in relation to the biomechanical factors driving peripheral pain stimuli [3]
The aim of the present study was to investigate the degree of intervertebral laxity, motion sharing inequality (MSI), Motion sharing variability (MSV) and sagittal translation during passive recumbent lumbar flexion and return motion in the lumbar spines of CNSLBP patients whose pain had failed to respond to treatment
Summary
Nonspecific low back pain that persists and is unresponsive to treatment (CNSLBP) constitutes the largest part of the health and socioeconomic impact of this problem [1]. As most back pain has come to be regarded as mechanical and related to function, back motion studies have been central in the search for functional biomarkers [5,6,7,8,9]. Intervertebral motion data provide more intrinsic information than surface studies and data from fluoroscopic sequences have been found to differentiate groups of patients with chronic nonspecific low back pain (CNSLBP) from healthy controls by virtue of the patterns of segmental motion [10, 11]. Discriminating variables have been identified as intervertebral laxity (measured as the rate of displacement of a vertebra from its neutral position) and the motion sharing inequality and variability during passive flexion (MSI and MSV) [10,11,12]
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