Abstract
Purpose and background
Recent research has identified possible functional biomarkers in chronic, nonspecific back pain (CNSLBP) based on intervertebral kinematics. Although excessive IV-RoM is no longer regarded as a clear motion abnormality, some studies have found subtle kinematic measures such as mid-range laxity and motion sharing inequality to be greater in CNSLBP patients. We studied a group of such patients who were investigated following failed interventions in terms of these subtle measures.
Methods
Thirty-seven patients (mean age 47.5 years SD10.87, F14, M23) with CNSLBP that had recently failed to respond to a range of treatments and 37 healthy controls received passive recumbent lumbar intervertebral flexion assessments following a standardised quantitative fluoroscopy (QF) protocol. Groups were compared for motion sharing inequality (MSI) and variability (MSV) (L2-S1), for level by level laxity and translation, and with reference ranges of these from a separate group of healthy controls (n=54).
Results
Patients had significantly higher MSI values than controls (p=0.01), but not MSV (p=0.79). Laxity and translation above normative reference limits were not more prevalent in patients. Eleven patients had had surgical or interventional procedures, 10 had spondylolisthesis or pars defects and 16 no disruptive elements. Those who had received invasive procedures (e.g. disc replacement, fusion) had significantly higher median MSI values than those with spondylolistheses/pars defects (p=0.02) or no disruption (p=0.001).
Conclusion
Reduced individual level intervertebral restraint during passive recumbent motion was not associated with pain in treatment resistant patients, but uneven restraint between levels (MSI) appeared to be. Future work should investigate the reasons for this.
No conflicts of interest
No funding obtained
