Pain Immediately Upon Sitting Down and Relieved by Standing Up Is Often Associated With Radiologic Lumbar Instability or Marked Anterior Loss of Disc Space

Abstract

Low back pain occurring immediately on sitting down and relieved on standing up was statistically associated with instability (specificity 100%, sensitivity 31%) or marked anterior loss of disc space in flexion (specificity 87%, sensitivity 55%).

Evaluation of Lumbar Spine Motion With Dynamic X-ray–A Reliability Analysis

“…29,30 However, reliability analyses of radiologic methods measuring ROM of the spine are scarce, although often used in most of the in vivo studies dealing with this item. 14,22,[25][26][27] Boden and Wiesel 26 reported an excellent intraobserver and interobserver reproducibility when measuring lumbar ROM with the Cobb method as they found no statistical significant difference between 2 measurements, verified by a paired t test of P Ͼ 0.05. The results of the current study show that a lack of statistical significant 25 ; it is noteworthy that all Pearson PCCs were Ͼ0.700.…”

“…Maigne et al 22 reported acceptable 95% CIs for the evaluation of ROM and static translation in different lumbar postures using dynamic radiograph. With respect to their results, they concluded that translation is easier to measure than rotation.…”

“…14,22,24 -28 Different radiologic methods have been described for the analysis of conventional flexion-extension radiographs to calculate the segmental ROM. Frequently used methods because of the simple handling and missing necessity for specific apparatus are the "Cobb-Method" (Figure 1) 14,22,25,26 and the "Superimposition-Method" (Figure 2). 23,24,28 The main problem in interpreting the values obtained from dynamic radiographs is the lack of accuracy and reliability measurements, especially when using different methods of analysis or observers with different training levels.…”

“…Clinically, the range of lumbar motion is considered important for the etiology, diagnosis, and treatment of many spinal pathologies. [22][23][24][25][26] Measuring segmental ROM becomes even more important as new dynamic stabilization methods of the lumbar spine are coming up. Because the postulated main advantage compared to fusion operation is the preservation of mobility, the quantification of movement will be of special clinical interest in future studies dealing with these techniques.…”

The myth of lumbar instability: the importance of abnormal loading as a cause of low back pain

“…Clearly none of these devices produce rigidity of a fusion, and the clinical efficacy would seem likely to be due to the fact that they prevent the spine from moving into a position where pain is experienced, (especially flexion) they certainly alter the loading patterns of the segment. The association of sitting pain (essentially flexion pain) with loading of the front of the disc is well shown in the paper by Maigne [23] where he demonstrated that patients who got pain sitting, relieved when they stood up, showed marked loss of the anterior disc space.…”