MECHANISM OF VERTICAL POSTURE FORMATION AND PARAMETERS OF SAGITTAL SPINOPELVIC BALANCE IN PATIENTS WITH CHRONIC LOW BACK PAIN AND SCIATICA

Objective.To study parameters of sagittal spinopelvic balance in patients with chronic low back pain and sciatica, and mechanism of vertical posture formation in a sagittal plane.Material and Methods.Total of 100 patients (32 female and 68 male, mean age 38.7 years) with chronic low back pain and sciatica underwent clinical and radiological examinations. Pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), and global lumbar lordosis (GLL) were measured on lateral standing radiograms. Statistical analysis of the obtained data was performed.Results.The mean value of PI (50.7°) in patients with back pain and sciatica and in healthy volunteers was almost equal, while SS and GLL were significantly lower in patients, and PT – higher, than those in volunteers. Number of patients with PI ≤ 35 was significantly higher than that of volunteers. Pearson’s correlation coefficient between GLL and PI was 0.916, between GLL and SS – 0.902, and between GLL and PT – 0.326. Vertical posture in patients with chronic low back pain and lumbar sciatica is characterised by backward pelvic rotation relative to hip and by hypolordotic shape of the lumbar spine.Conclusion.Vertical posture in patients with low back pain and sciatica is determined by a backward rotation of the pelvis, therefore SS and GLL decrease, and PT increases. A prevalence of extremely low values of PI (≤35°) may be considered as a risk factor for lumbar spine degenerative diease. Alteration of vertical posture is a kind of protective mechanism.

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POS1289 CHRONIC LOW BACK PAIN: THERAPEUTIC STRATEGIES AND CLINICAL OUTCOMES IN A MILITARY POPULATION

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.4149 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 926.2-926

Author(s):

R. Dhahri ◽

A. Dghaies ◽

M. Slouma ◽

L. Metoui ◽

I. Gharsallah ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Spine ◽

Physical Examination ◽

Chronic Low Back Pain ◽

Radicular Pain ◽

Abdominal Muscles ◽

Low Back ◽

Number Of Patients ◽

The Impact

Background:Low back pain is an extremely common patient complaint. Most cases resolve quickly after the acute episode. However, a significant number of patients develop chronic low back pain; a persistent disabling condition. Patients suffer from unremitting pain and often become functionally impaired.Objectives:The aim of this study is to describe the characteristics of chronic LBP, physical examination abnormalities, treatment strategies and the impact of LBP on the professional life of the patients.Methods:It was a an analytical cross-sectional study including 50 patients with at least three months of LBP, in the department of rheumatology and orthopedics at the Military Hospital of Tunis between January 1st and March 31, 2020. All patients had a standardized investigation and clinical assessment.Results:The study included 80% of active military serving members and 20% of administrative officers. The mean age of the patients was 41.9 ± 8.4 years and the sex ratio was 4.5. Four patients were suffering from diabetes; two patients were suffering from high blood pressure. All the patients were suffering from chronic LBP lasting for an average of 66.4 months. LBP was associated with radicular pain in 78% of the cases. It was a unilateral radicular pain in 72% of the cases and bilateral in 28% of the cases. The main triggering factors were: carrying heavy loads in 98% of the cases, standing or sitting for long periods in 90% and 76% of the cases, tremors in 74% of the cases. Neuropathic pain was found in 26% of patients. Physical examination showed paravertebral muscle tenderness in 66% of the cases and slack abdominal muscles in 56% of the cases. Assessement of range of flexion of the lumbar spine showed: fingertip to floor test was 18 ±12.2 cm [054cm], schober test was +3.8±1.2cm [16cm]. The extension of lumbar spine was painful in 80% of the cases. A trigger point was found in 28% of the cases. Lasegue sign was positive in 18% of the cases. Leri’s test was positive in 8% of the cases. Required treatments during the last episode of LBP were: Paracetamol (62%), nonsteroidal antiinflammatory drugs (26%), tramadol (4%), myorelaxant (4%) and pregabalin (2%). Half of the patients needed functional rehabilitation. Forty percent of the patients reported improvement; 46% of them reported improvement then recurrence of the pain, 8% of them reported no improvement and 4% reported worsening of the symptoms. Thirty six percent of the patients needed an average of 21 days of leave and 35% of them needed exemption from work for LBP problems. One patient needed an outplacement from his original work and one patient needed an early retirement.Conclusion:Chronic low back pain can cause significant functional disability, and commonly becomes frustrating for both patients and physicians to cope with and treat. There is still no consensus on the best way to manage chronic low back pain, and clinical guidelines are scarce. A combination of pharmacological agents and non-pharmacological methods is the most appropriate therapeutic regimen.Disclosure of Interests:None declared

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Immediate effect of thoracic mobilization on trunk motion, pain sensation and lumbar spine muscle activity in patients with chronic low back pain

http://isrctn.com/ ◽

10.1186/isrctn75190733 ◽

2021 ◽

Author(s):

Amornthep Jankaew

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Spine ◽

Chronic Low Back Pain ◽

Muscle Activity ◽

Low Back ◽

Pain Sensation ◽

Trunk Motion

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Interrater Reliability of a Movement Impairment-Based Classification System for Lumbar Spine Syndromes in Patients With Chronic Low Back Pain

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.2008.2760 ◽

2008 ◽

Vol 38 (6) ◽

pp. 371-376 ◽

Cited By ~ 43

Author(s):

Elaine Trudelle-Jackson ◽

Shweta A. Sarvaiya-Shah ◽

Sharon S. Wang

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Spine ◽

Chronic Low Back Pain ◽

Classification System ◽

Interrater Reliability ◽

Low Back

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Effects of infrared radiation and shortwave diathermy on the patients with chronic low back pain due to osteoarthritis of the lumbar spine

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2019.02.475 ◽

2019 ◽

Vol 27 ◽

pp. S443-S444

Author(s):

M.A. Shakoor

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Spine ◽

Chronic Low Back Pain ◽

Infrared Radiation ◽

Low Back ◽

Shortwave Diathermy

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SPECT/CT imaging of the lumbar spine in chronic low back pain: a case report

Chiropractic & Manual Therapies ◽

10.1186/2045-709x-19-2 ◽

2011 ◽

Vol 19 (1) ◽

Cited By ~ 7

Author(s):

Michael H Carstensen ◽

Mashael Al-Harbi ◽

Jean-Luc Urbain ◽

Tarik-Zine Belhocine

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Case Report ◽

Lumbar Spine ◽

Chronic Low Back Pain ◽

Ct Imaging ◽

Low Back

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Clinical Review of Lumbar Spine Fusion for Chronic Low Back Pain Due to Degenerative Disc Disease

The Spine Journal ◽

10.1016/j.spinee.2012.08.382 ◽

2012 ◽

Vol 12 (9) ◽

pp. S147-S148 ◽

Cited By ~ 2

Author(s):

Frank M. Phillips ◽

Paul J. Slosar ◽

Jim A. Youssef ◽

Gunnar B. Andersson ◽

Frank J. Papatheofanis

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Spine ◽

Clinical Review ◽

Chronic Low Back Pain ◽

Degenerative Disc Disease ◽

Spine Fusion ◽

Low Back ◽

Disc Disease ◽

Lumbar Spine Fusion

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Atraumatic Bilateral Lumbar Pedicle Fractures in a Patient with Back Pain and History of Long- Term Bisphosphonate Therapy: A Case Report

Pain Management Case Reports ◽

10.36076/pmcr.2020/4/97 ◽

2020 ◽

pp. 97-102

Author(s):

Alec L. Meleger

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Case Report ◽

Lumbar Spine ◽

Conservative Management ◽

Chronic Low Back Pain ◽

Bisphosphonate Therapy ◽

Low Back ◽

History Of ◽

Lumbar Pedicle

of atypical femoral fractures is a known complication of chronic bisphosphonate therapy; however, the finding of atraumatic lumbar pedicle fractures without a prior history of spinal surgery or contralateral spondylolysis is rare. While a few cases of osteoporotic pedicle fractures associated with adjacent vertebral compression fractures have been reported, only a single case of isolated atraumatic bilateral pedicle fractures has been published in a patient who had been on chronic risedronate therapy of 10-year duration. Case Report: The present case report illustrates a 63-year-old man who developed isolated atraumatic bilateral lumbar pedicle fractures after 3 years and 5 months on alendronate treatment. The patient’s past medical history had been significant for osteoporosis with a lumbar spine T-score of -2.7. At the time of initial diagnosis, a comprehensive work-up for secondary causes of osteoporosis proved to be negative; this was followed by initiation of bisphosphonate treatment with 70 mg of alendronate once per week. Ten months after starting bisphosphonate therapy, he underwent magnetic resonance imaging (MRI) of the lumbar spine for low back pain that had not responded to conservative management, with imaging not revealing any evidence of pedicle fractures or pedicle stress reaction. He was again seen in the spine clinic, for atraumatic exacerbation of his chronic low back pain with concurrent right lower extremity radiation, 6 months after stopping bisphosphonate therapy. Since the patient failed to respond to conservative management over the ensuing 6 months, a repeat MRI was obtained, which showed new acute/subacute bilateral L5 pedicle fractures. Conclusion: An isolated atraumatic lumbar pedicle fracture may be an additional type of atypical fracture associated with chronic bisphosphonate therapy in an osteoporotic patient. Key words: Chronic low back pain, bisphosphonate, alendronate, pedicle fracture Pain Medicine

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A Comparison of Pressure Pain Detection Thresholds in People With Chronic Low Back Pain and Volunteers Without Pain

Physical Therapy ◽

10.1093/ptj/85.10.1085 ◽

2005 ◽

Vol 85 (10) ◽

pp. 1085-1092 ◽

Cited By ~ 68

Author(s):

R Jason S Giesbrecht ◽

Michele C Battié

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Spine ◽

Chronic Low Back Pain ◽

Primary Care Physicians ◽

Detection Threshold ◽

Test Site ◽

Low Back ◽

Pressure Pain ◽

Pain Detection

Abstract Background and Purpose. Palpation is often utilized in the physical examination of patients with low back pain. The purpose of this study was to compare the pressure pain detection threshold (PPDT) of people with chronic low back pain (CLBP) and subjects without pain. Subjects and Methods. Thirty female subjects with CLBP were recruited from the offices of primary care physicians and physical therapists and compared with 30 female volunteers without pain for differences in PPDT at 6 sites tested bilaterally. Results. A significantly lower mean PPDT was found for all test site groups in subjects with CLBP compared with subjects without pain. A lower global PPDT was found in subjects with CLBP compared with subjects without pain (5.6 lb/cm2 versus 6.9 lb/cm2). This also was the case for PPDT for the group of test sites unrelated to the lumbar spine (5.1 lb/cm2 versus 6.1 lb/cm2) and for PPDT related to the lumbar spine (5.9 lb/cm2 versus 8.0 lb/cm2). Discussion and Conclusion. Neurobiological or biopsychosocial influences may have contributed to the lower PPDT evident in subjects with CLBP. Subjects with CLBP demonstrated a lower global PPDT compared with subjects without pain, which should be taken into account when interpreting findings of pain or tenderness from palpation.

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