Abstract
Background: Diagnosing intervertebral instability is crucial for the treatment of degenerative lumbar spondylolisthesis (DLS). Disabling back pain will reduce spinal mobility which leads to an underestimate of the incidence of intervertebral instability. We hypothesized that adequate analgesia could alter the flexion/extension exam performance, and thus increase the diagnostic accuracy of segmental instability. Materials and methods: One hundred patients with low-grade DLS were prospectively enrolled in the before–after cohort study. Standing lateral flexion/extension radiographs of lumbar spines were examined and analyzed before and after intramuscular injections of 30 mg ketorolac. Results: Pain score decreased significantly after analgesic injections (p < 0.001). Dynamic slip (DS), dynamic segmental angle (DA), dynamic lumbar lordosis, and slip percentage (SP) were significantly increased after pain reduction (all p < 0.001). According to the diagnostic criteria for segmental instability (DS > 4.5 mm, DA > 15°, or SP > 15%), there were 4%, 4%, and 0.7% of total motion segments fulfilling the criteria which markedly increased to 42%, 32%, and 16.7% after analgesia was administered. The incidence of instability also increased from 6% to 38% after analgesia. Conclusions: The diagnosis rate of intervertebral instability is commonly underestimated in the presence of low back pain. This short-term pain relief facilitates reliable functional imaging adding to the diagnosis of intervertebral instability.
Highlights
Low back pain (LBP) is the most common musculoskeletal disorder and the leading cause of disability endured for years [1]
The purpose of this study is to investigate the pain control efficacy of fastacting analgesia in patients with chronic symptomatic degenerative lumbar spondylolisthesis (DLS) and the changes in radiologic parameters of intervertebral instability in lateral flexion/extension radiographs of the lumbar spine
The present study examined the effect of alleviating LBP on the variables measured 4f.rDomiscfluesxsiioonn/extension radiographs of the lumbar spine
Summary
Low back pain (LBP) is the most common musculoskeletal disorder and the leading cause of disability endured for years [1]. Spondylolisthesis with segmental instability can lead to disabling LBP symptoms and neurologic deficits [4], and the management tends to involve spinal fusion surgery when conservative treatment has failed [5,6]. Degenerative lumbar spondylolisthesis (DLS) is a common cause of chronic LBP, and the evaluation of segmental stability is considered an important factor to determine the treatment of patients with DLS [5,7]. Disabling back pain will reduce spinal mobility which leads to an underestimate of the incidence of intervertebral instability. Conclusions: The diagnosis rate of intervertebral instability is commonly underestimated in the presence of low back pain. This short-term pain relief facilitates reliable functional imaging adding to the diagnosis of intervertebral instability
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have