Ann Rehabil Med.  2019 Feb;43(1):38-44. 10.5535/arm.2019.43.1.38.

Does Adequate Lumbar Segmental Motion Reflect Recovery Process in Acute Lumbar Disc Herniation?

• Kim H
• Jung HJ
• Kim M
• Koh SE
• Lee IS

• KMID: 2440950
• DOI: http://doi.org/10.5535/arm.2019.43.1.38

Abstract

OBJECTIVE
To investigate if the extent of lumbar segmental motion is correlated with the recovery process in the form of pain intensity in patients with acute single level lumbar disc herniation (LDH).
METHODS
A retrospective review of medical records was performed on patients presented with acute low back pain from January 2011 to December 2017. With prerequisites of undergoing both lumbar spine magnetic resonance imaging and functional radiography, patients with etiologies other than single level LDH were excluded. A total of 46 patients were selected, including 27 patients with disc herniation at L4-5 level and 19 patients at L5-S1 level. Pearson correlation analysis of pain intensity against segmental range of motion (sROM) and percentage of sROM of each lumbar segment was performed at the initial evaluation point and follow-ups.
RESULTS
Serial documentation of pain intensity and functional radiography exhibited an inverse correlation between changes in visual analogue scale (VAS) and sROM in single level LDH at L4-5 level (r=-0.69, p < 0.05). In addition, percentage of sROM showed a negative correlation with pain intensity at the aforementioned segment (r=-0.74, p < 0.05). Initial pain intensity was also inversely correlated to sROM of the affected segment (r=-0.83, p < 0.01 at L4-5; r=-0.82, p < 0.05 at L5-S1).
CONCLUSION
Improvement in sagittal mobility of the affected segment in LDH adequately reflected mitigation of low back pain during the recovery process. This conjunction could illustrate that the involved segment is overcoming natural immobilization, evidently demonstrating an inverse relationship between initial pain intensity and limitation of sagittal range of motion.

Keyword

Low back pain; Intervertebral disc displacement; Range of Motion; Articular

MeSH Terms

Follow-Up Studies
Humans
Immobilization
Intervertebral Disc Displacement
Low Back Pain
Magnetic Resonance Imaging
Medical Records
Radiography
Range of Motion, Articular
Retrospective Studies
Spine

Figure

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  Fig. 1. A diagram depicting the process of patient selection.

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  Fig. 2. Method of quantifying sagittal range of motion (sROM) of each lumbosacral segment calculated by first measuring the angle between superior and inferior end plates in flexion (A) and extension (B) radiographs and making subtraction at each respective segment. In this particular patient, sROMs of the five lumbosacral segments L1-2, L2-3, L3-4, L4-5, and L5-S1 were determined to be 6°, 9°, 5°, 7°, and 3°, respectively.

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