Scoliosis: Chronic Low Back Pain

Scoliosis Journal recently posted about unspecific chronic low back pain - a simple functional classification tested in a case series of patients with spinal deformities

Authors: Hans-Rudolf Weiss and Mario Werkmann

Published: 17 February 2009

Background
Up to now, chronic low back pain without radicular symptoms are not classified and attributed in international literature as being "unspecific". For specific bracing of this group of patients suffering from low back pain we use simple physical tests to predict the brace type the patient might benefit from. Based on these physical tests we have developed a simple functional classification of "unspecific" low back pain in patients with spinal deformities.

Methods
Between January 2006 and July 2007 we have tested 130 patients (116 females and 14 males) with spinal deformities (average age 45 years, ranging from 14 years to 69) and chronic unspecific low back pain (pain for > 24 months) after the indication for brace treatment for chronic unspecific low back pain was seen. Some of the patients had symptoms of spinal claudication (n=16). We applied the "sagittal realignment test" (SRT), a lumbar hyperextension test, and the "sagittal delordosation test" (SDT). Additionally 3 female patients with spondylolisthesis have been tested for brace treatment, one with symptoms of spinal claudication as well. Two of these patients where 14 years of age and the other 43.

Results
117 Patients reported significant pain release in the SRT and 13 in the SDT (>/= 2 steps in the Roland & Morris VRS). 3 Patients had no significant pain release in both of the tests (< 2 steps in the Roland & Morris VRS). Pain intensity was high (3,29) before performing the physical tests (VRS-scale 0-5) and low (1,37) while performing the physical test for the whole sample of patients. The differences where highly significant in the Wilcoxon test (z = - 3,79; p < 0,0001). In the 16 patients who did not respond to the SRT in the manual investigation we found a hypermobility L5/S1 or a spondylolisthesis L5/S1. In the other patients who respoded well to the SRT loss of lumbar lordosis was the main issue, a finding which, according to actual knowledge, is correlated well with low back pain. The three patients who did not respond to either test had a fair pain reduction in a generally delordosating brace with an isolated small foam pad inserted to the level of L 2/3, leading to a lordosation at this region, only.

Discussion
With the exception of three patients (2,3%) a clear distribution to one of the two classes has been possible. 117 Patients were supplied successfully with a sagittal realignment brace (physio-logic braceTM) and 13 with a sagittal delordosation brace (spondylogic(R) brace). Therefore a clear distribution of the patients from this sample to either chronic postural or chronic instability back pain was possible. In 2,3% a combined chronic low back pain from the findings obtained seems reasonable to assume.

Conclusions
Chronic unspecific low back pain is possible to clearly be classified physically. This functional classification is necessary to decide on which specific conservative approach (physical therapy, braces) should be used. Other factors than spinal deformities contribute to chronic low back pain.

Download the full version in PDF from Scoliosis Journal

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