Is L5-S1 motion segment different from the rest? A radiographic kinematic assessment of 72 patients with chronic low back pain.

Sabnis, AB; Chamoli, U; Diwan, AD

Is L5-S1 motion segment different from the rest? A radiographic kinematic assessment of 72 patients with chronic low back pain.

Sabnis, AB Chamoli, U

Diwan, AD

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Publisher:: SPRINGER
Publication Type:: Journal Article
Citation:: Eur Spine J, 2018, 27, (5), pp. 1127-1135
Issue Date:: 2018-05

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Field	Value	Language
dc.contributor.author	Sabnis, AB
dc.contributor.author	Chamoli, U https://orcid.org/0000-0002-8396-5814
dc.contributor.author	Diwan, AD
dc.date.accessioned	2022-09-11T20:40:50Z
dc.date.available	2017-11-18
dc.date.available	2022-09-11T20:40:50Z
dc.date.issued	2018-05
dc.identifier.citation	Eur Spine J, 2018, 27, (5), pp. 1127-1135
dc.identifier.issn	0940-6719
dc.identifier.issn	1432-0932
dc.identifier.uri	http://hdl.handle.net/10453/161675
dc.description.abstract	PURPOSE: The relationship between biomechanical instability and degenerative changes in the lumbar spine in chronic low back pain (CLBP) patients remains controversial. The main objective of this retrospective radiographical study was to evaluate changes in kinematics at different lumbar levels (in particular the L5-S1 level) with progressive grades of disc degeneration and facet joint osteoarthritis in CLBP patients. METHODS: Using standing neutral and dynamic flexion/extension (Fx/Ex) radiographs of the lumbar spine, in vivo segmental kinematics at L1-L2 through L5-S1 were evaluated in 72 consecutive CLBP patients. Disc degeneration was quantified using changes in signal intensity and central disc height on mid-sagittal T2-weighted magnetic resonance (MR) scans. Additionally, the presence or absence of facet joint osteoarthritis was noted on T2-weighted axial MR scans. RESULTS: Disc degeneration and facet joint osteoarthritis occurred independent of each other at the L5-S1 level (p = 0.188), but an association was observed between the two at L4-L5 (p < 0.001) and L3-L4 (p < 0.05) levels. In the absence of facet joint osteoarthritis, the L5-S1 segment showed a greater range of motion (ROM) in Ex (3.3° ± 3.6°) and a smaller ROM in Fx (0.6° ± 4.2°) compared with the upper lumbar levels (p < 0.05), but the differences diminished in the presence of it. In the absence of facet joint osteoarthritis, no change in L5-S1 kinematics was observed with progressive disc degeneration, but in its presence, restabilisation of the L5-S1 segment was observed between mild and severe disc degeneration states. CONCLUSION: The L5-S1 motion segment exhibited unique degenerative and kinematic characteristics compared with the upper lumbar motion segments. Disc degeneration and facet joint osteoarthritis occurred independent of each other at the L5-S1 level, but not at the other lumbar levels. Severe disc degeneration in the presence of facet joint osteoarthritis biomechanically restabilised the L5-S1 motion segment.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	SPRINGER
dc.relation.ispartof	Eur Spine J
dc.relation.isbasedon	10.1007/s00586-017-5400-4
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	0903 Biomedical Engineering, 1103 Clinical Sciences
dc.subject.classification	Orthopedics
dc.subject.mesh	Biomechanical Phenomena
dc.subject.mesh	Chronic Pain
dc.subject.mesh	Humans
dc.subject.mesh	Intervertebral Disc Degeneration
dc.subject.mesh	Low Back Pain
dc.subject.mesh	Lumbar Vertebrae
dc.subject.mesh	Osteoarthritis, Spine
dc.subject.mesh	Radiography
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Sacrum
dc.subject.mesh	Lumbar Vertebrae
dc.subject.mesh	Sacrum
dc.subject.mesh	Humans
dc.subject.mesh	Low Back Pain
dc.subject.mesh	Radiography
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Osteoarthritis, Spine
dc.subject.mesh	Intervertebral Disc Degeneration
dc.subject.mesh	Chronic Pain
dc.subject.mesh	Biomechanical Phenomena
dc.title	Is L5-S1 motion segment different from the rest? A radiographic kinematic assessment of 72 patients with chronic low back pain.
dc.type	Journal Article
utslib.citation.volume	27
utslib.location.activity	Germany
utslib.for	0903 Biomedical Engineering
utslib.for	1103 Clinical Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Engineering and Information Technology
pubs.organisational-group	/University of Technology Sydney/Strength - CHT - Health Technologies
pubs.organisational-group	/University of Technology Sydney/Faculty of Engineering and Information Technology/School of Biomedical Engineering
pubs.organisational-group	/University of Technology Sydney/Centre for Health Technologies (CHT)
utslib.copyright.status	closed_access	*
dc.date.updated	2022-09-11T20:40:48Z
pubs.issue	5
pubs.publication-status	Published
pubs.volume	27
utslib.citation.issue	5

Abstract:

PURPOSE: The relationship between biomechanical instability and degenerative changes in the lumbar spine in chronic low back pain (CLBP) patients remains controversial. The main objective of this retrospective radiographical study was to evaluate changes in kinematics at different lumbar levels (in particular the L5-S1 level) with progressive grades of disc degeneration and facet joint osteoarthritis in CLBP patients. METHODS: Using standing neutral and dynamic flexion/extension (Fx/Ex) radiographs of the lumbar spine, in vivo segmental kinematics at L1-L2 through L5-S1 were evaluated in 72 consecutive CLBP patients. Disc degeneration was quantified using changes in signal intensity and central disc height on mid-sagittal T2-weighted magnetic resonance (MR) scans. Additionally, the presence or absence of facet joint osteoarthritis was noted on T2-weighted axial MR scans. RESULTS: Disc degeneration and facet joint osteoarthritis occurred independent of each other at the L5-S1 level (p = 0.188), but an association was observed between the two at L4-L5 (p < 0.001) and L3-L4 (p < 0.05) levels. In the absence of facet joint osteoarthritis, the L5-S1 segment showed a greater range of motion (ROM) in Ex (3.3° ± 3.6°) and a smaller ROM in Fx (0.6° ± 4.2°) compared with the upper lumbar levels (p < 0.05), but the differences diminished in the presence of it. In the absence of facet joint osteoarthritis, no change in L5-S1 kinematics was observed with progressive disc degeneration, but in its presence, restabilisation of the L5-S1 segment was observed between mild and severe disc degeneration states. CONCLUSION: The L5-S1 motion segment exhibited unique degenerative and kinematic characteristics compared with the upper lumbar motion segments. Disc degeneration and facet joint osteoarthritis occurred independent of each other at the L5-S1 level, but not at the other lumbar levels. Severe disc degeneration in the presence of facet joint osteoarthritis biomechanically restabilised the L5-S1 motion segment.

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http://hdl.handle.net/10453/161675