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Spine Feature

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New Insights Into Causes of Back Pain

Elizabeth Hofheinz, M.P.H., M.Ed. • Tue, February 13th, 2018

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It looks like we are inching closer to personalized spine disorder diagnosis. Researchers from the United Kingdom have published new work indicating that motion sharing is more unequal in nonspecific low back pain patients than in healthy patients.

Uneven intervertebral motion sharing is related to disc degeneration and is greater in patients with chronic, non-specific low back pain: an in vivo, cross-sectional cohort comparison of intervertebral dynamics using quantitative fluoroscopy,” appears in the January 2018 edition of the European Spine Journal.

Co-author Alan Breen, Ph.D., professor of Musculoskeletal Research at Bournemouth University in Poole, UK, commented to OTW, “We were investigating the possibility of there being personalized biomechanical markers for nonspecific back pain, which is the world’s largest cause of lifetime disability.”

“The study used quantitative fluoroscopy to measure the sharing of motion between the lumbar vertebrae continuously in patients whose trunk motion was controlled, to avoid behavioral variations. As far as we know, we are the only group to have done this.”

The authors wrote, “Twenty patients with chronic, non-specific low back pain (CNSLBP) and 20 matched controls received quantitative fluoroscopic lumbar spine examinations using a standardised protocol for data collection and image analysis.”

“Composite disc degeneration (CDD) scores comprising the sum of Kellgren and Lawrence grades from L2–S1 were obtained. Indices of intervertebral motion sharing inequality (MSI) and variability (MSV) were derived and expressed in units of proportion of lumbar range of motion from outward and return motion sequences during lying (passive) and standing (active) lumbar bending and compared between patients and controls.”

“Motion sharing between lumbar vertebrae is not normally completely equal, but this study found that it is significantly more unequal in nonspecific low back pain patients than in healthy controls. We also found that uneven motion sharing was strongly correlated to the amount of disc degeneration in the lumbar spine, but only in the nonspecific low back pain patients.”

“When patients present with nonspecific back pain that has mainly mechanical features (as opposed to inflammatory or central sensitization ones), we should consider the possibility of increased variability of intervertebral restraint as a contributing factor.”

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