Lumbar Symptoms Research Articles

Lumbar Sagittal Mobility and Low Back Symptoms in Patients Treated with Manipulation

The relationship between lumbar sagittal mobility and symptoms was explored in a 1-year prospective study of 55 patients undergoing manipulative treatment. A significant increase in mean mobility was found to occur in the 1st month, together with a concomitant significant decrease in mean pain values; symptoms continued to decrease thereafter, but mobility remained unchanged. More detailed analysis of the data revealed that symptomatic improvement was as common in patients with unaltered or reduced mobility as it was in those who showed an increase; changes in mobility at 1 month had no predictive value for symptomatic status at 1 month or 1 year. It is concluded that if any benefits actually result from manipulative therapy they are not a direct function of increased overall lumbar sagittal mobility. It remains possible that manipulation may influence other mobility parameters, such as coupled motions, so future studies should be directed toward investigation of three-dimensional movement patterns.

選択的神経根ブロックの効果

Selective radiculography and block (SRB) were carried out on 150 cases with cervical and lumbar radicular symptoms. Of 150 cases with SRB, 74 subsequently had surgical exploration of the suspected lesion, when SRB was helpful to determine the level of symptoms. Eleven cases (7.3%) were improved for more than one month. SRB was occasionally useful as a therapeutic method.

The Inter-Therapist Reliability of the Slump Test

This study examined the inter-therapist reliability of the slump test. Six pairs of physiotherapists tested a total of 93 patients currently receiving treatment for lumbar and/or lower limb symptoms. Each pair performed two slump tests on patients during a normal clinical visit. The slump test was positive if the patients' symptoms were reproduced, and subsequently decreased with cervical extension. A second definition of positive slump required decreased symptoms and increased knee extension with cervical extension. The results indicated that the slump test has high inter-therapist reliability which is consistent with reliability findings for related clinical tests of pain.

The Patello-Femoral Pain Syndrome: A Clinical Trial of the McConnell Programme

In an uncontrolled clinical trial, 116 patients from a general population were treated with the McConnell programme for patello-femoral pain syndrome. This programme, consisting of a detailed knee assessment and treatment using a taping technique for pain relief, isometric and eccentric exercise, produced excellent to good results in 86 per cent of patients within five treatments and maintained those results one year after the cessation of treatment. Sex, current activities, duration of symptoms, abnormal foot pronation, iliotibial tract and hamstring tightness and other positive passive movement tests had no effect on the outcome of the treatment. Patients over 38 years of age had only an equal chance of being pain free with five treatments. The presence of concurrent lumbar symptoms increased the time required for positive response to the treatment (p<0.001).

Risk of recurrence of occupational back pain over three year follow up.

A random sample including 2342 cases representative of all occupational back injuries in Quebec (1981) was followed up prospectively over three years to assess the recurrence rate of back problems (lumbar, thoracic, and cervical). Each medical and accident report was reviewed to obtain the site of symptoms and occupation. Age, sex, industrial sector, and number of episodes of absence from work were abstracted from the computerised Quebec Compensation Board files. The recurrence rate was 20.0% at one year follow up and 36.3% at three years. A multivariate analysis using a Poisson regression, was performed to model the risk of recurrence over time. Men had a higher chance of recurrence (risk ratio = 1.85, 95% CI = 1.50-2.27) but among recurrent cases, the average total number of episodes was comparable between men and women. Age showed a protective effect on the probability of recurrence (10 years: RR = 0.93, 95% CI = 0.88-0.98) due to the lower recurrence rate in the 45-64 year old group (31.8%). Cervical and lumbar symptoms had identical recurrence profiles whereas thoracic symptoms had a significantly lower recurrence rate. Drivers had the highest recurrence rate (42.1%) and nurses had the highest average number of recurrences (2.03) among recurrent cases. Both occupations had statistically significant excesses after controlling for the other variables.

高令者（６０才以上）の腰椎疾患のレ線学的検討

We studied the relation between radiographic changes of the lumbar spine and symptoms in the buck and lower extremities. Sixty-two cases, above sixty years old, were picked up for this study. Radiography was taken in the erect position. Scoliosis, lordosis, sacral inclination and olisthesis were measured.Forty cases (60%) had lumbar scoliosis above five degrees. There was no sex difference but female patients showed large curves. Olisthesis existed in twenty-five patients (40%). There was a female prevalence. Anterior olisthesis occurred mostly in lower part and retro, lateral olisthesis in middle part. Frequency of combined scoliosis and olisthesis was eighty percent.Patients with olisthesis had long history of lumbago and leg symptoms and more disturbance in daily life than patients without olisthesis. They had been poorly improved by conservative treatment. We think that some patients with malalingnment of the lumbar spine are better treated by early surgical intervention.

Surgical management of isthmic spondylolisthesis.

In order to determine the factors that produce a successful outcome in the surgical management of spondylolisthesis, 44 consecutive patients who underwent surgical treatment were reviewed. Preoperative evaluation was directed towards determining the presence or absence of nerve root compression. The patients without nerve root compression typically underwent fusion alone, while those with evidence of nerve root compression had decompression and fusion. After an average 36-month follow-up, results were good in 78%, fair in 18%, and poor in 4%. There were five complications, all of which were successfully managed. Two patients required reoperation for pseudoarthrosis. An eventual 100% fusion rate was achieved. Results in the patients with Grade III or Grade IV olisthesis were nearly equivalent to the less severe cases. Nine patients received allograft, with a fusion rate equal to the 32 receiving autogenous bone. This study suggests that in patients who have isthmic spondylolisthesis with mechanical lumbar symptoms only, or in patients with low-back pain with radicular extremity pain caused by nerve root irritation, fusion alone is indicated. In patients with documented radiculopathy resulting from nerve root compression, decompression in addition to fusion is indicated.

Lytic spondylolisthesis above the lumbosacral level.

The syndrome produced by lytic spondylolisthesis depends on the level at which it occurs. Above the lumbosacral level the incidence of neurologic signs and spinal stenosis increases, and further forward slip in adult life is not uncommon. Twenty-seven patients with lesions above the fifth lumbar vertebra and symptoms severe enough to warrant surgery were studied. Some radiologic observations are made. The patients were divided into two groups for assessment of the results of surgery. Patients with no neurologic signs obtained satisfactory results after a fusion procedure alole. Patients with a neurologic deficit fared less well after surgery, and the importance of decompression in this group is stressed.

Retroperitoneal, Lumbar, and Pelvic Malignancies Simulating the "Disc Syndrome"

This paper deals with 13 patients who were suspected of having a lumbar herniated nucleus pulposus because of their lumbar nerve root symptoms. In all the cause of pain and other findings was eventually found to be due to a lumbar, pelvic, or retroperitoneal malignancy. Several patients were thought to be either primarily psychotic, or at least psychoneurotic, because of their psychologic reaction to their pain. Study of these patients has enabled us to divide them into three groups. The first group of three patients all seemed to have been in good general health prior to the onset of their back pain. Case 1. —The patient was a 62-year-old railroad employee with that type of back trouble supposedly common to railroad employees. He had been hospitalized for a period of time in December of 1954, and at that time films of the lumbar spine and chest were normal. He seemed