The Kinematics and Spondylosis of the Lumbar Spine Vary Depending on the Levels of Motion Segments in Individuals With Low Back Pain

Abstract

Study Design Prospective cohort study. Objective To identify associations of spondylotic and kinematic changes with low back pain (LBP). Summary of Background Data The ability to characterize and differentiate the biomechanics of both the symptomatic and asymptomatic lumbar spine is crucial to alleviate the sparse literature on the association of lumbar spine biomechanics and LBP. Methods Lumbar dynamic plain radiographs (flexion-extension), dynamic CT scanning (axial rotation, disc height) and MRI (disc and facet degeneration grades) were obtained for each subject. These parameters were compared between symptomatic and control groups using Student’s t-test and multivariate logistic regression, which controlled for patient age and sex and identified spinal parameters that were independently associated with symptomatic LBP. Disc grade and mean segmental motion by level were tested by one-way ANOVA. Results Ninety-nine volunteers (64 asymptomatic/35 LBP) were prospectively recruited. Mean age was 37.3±10.1 y.o. and 55% were male. LBP showed association with increased L5/S1 translation (odds ratio [OR] 1.63 per mm, p=0.005), decreased flexion-extension motion at L1/L2 (OR 0.87 per degree, p=0.036), L2/L3 (OR 0.88 per degree, p=0.036), and L4/L5 (OR 0.87 per degree, p=0.020), increased axial rotation at L4/L5 (OR 2.11 per degree, p=0.032), decreased disc height at L3/L4 (OR 0.52 per mm, p=0.008) and L4/L5 (OR 0.37 per mm, p<0.001), increased disc grade at all levels (ORs 2.01–12.33 per grade, p=0.001–0.026), and increased facet grade at L4/L5 (OR 4.99 per grade, p=0.001) and L5/S1 (OR 3.52 per grade, p=0.004). Significant associations were found between disc grade and kinematic parameters (flexion-extension motion, axial rotation, and translation) at L4/L5 (p=0.001) and L5/S1 (p<0.001), but not at other levels (p>0.05). Conclusions In symptomatic individuals, L4/L5 and L5/S1 levels were affected by spondylosis and kinematic changes. This study clarifies the relationships between kinematic alterations and LBP, mostly observed at the above-mentioned segments.

Evaluation of segmental mobility in patients with lumbar spondylolisthesis : A comparison of images from standing flexion-extension and standing/supine slippage

“…Currently, many reports about factors associated with lumbar segmental mobility were described (11)(12)(13)(14)(15). Some factors, such as sex, disc degeneration, and facet osteoarthritis, have also been reported.…”

How is spinal range of motion affected by disc- and facet degeneration and spinopelvic anatomy?

“…These in turn may lead to abnormal spinal motion or instability at the affected segment [7,13]. Although previously investigated, both in vitro [7,14,15] and in vivo [16][17][18], the effect of FJD on spinal kinematics and the combined effect of lumbar IDD and FJD remain poorly understood [8,13,19,20]. The interrelation between IDD, FJD, overall and segmental lumbar angular motion, and spinopelvic parameters in a cohort of lumbar fusion patients has not been particularly addressed, and it remains unclear findings in this population compare to previous ones.…”

The Influence of Kinematic Constraints on Model Performance During Inverse Kinematics Analysis of the Thoracolumbar Spine

“…For instance, LBP accounts for ~40% of lost workdays with an estimated direct healthcare expenditure of $50–90 billion annually in the US (Guo et al, 1999 ; Yang et al, 2016 ). Many spinal disorders, including idiopathic back pain, degenerative disc disease, lumbar spinal stenosis, vertebral fractures (traumatic or osteoporotic), spine deformity, and muscle imbalance (e.g., myopathy, muscle dystrophy), can alter the kinematics and posture of the trunk (Al-Eisa et al, 2006 ; Briggs et al, 2007 ; Mahaudens et al, 2009 ; Galvis et al, 2016 ; Kuwahara et al, 2016 ; Schmid et al, 2016 ; Basques et al, 2017 ; Christe et al, 2017 ; Chun et al, 2017 ; Crawford et al, 2018 ; Igawa et al, 2018 ). Therefore, objective measurements of trunk kinematics and posture are useful in evaluating the functional impacts of spinal disorders and the development of novel clinical treatments.…”