Top

European Spine Journal

Published in:

01-03-2013 | Original Article

Dose response and structural injury in the disability of spinal injury

Authors: Mohammed Shakil Patel, Philip Sell

Published in: European Spine Journal | Issue 3/2013

Abstract

Introduction

In traumatic injury there is a clear relationship between the dose of energy involved, structural tissue damage and resultant disability after recovery. This relationship is often absent in cases of non-specific chronic low back pain that is perceived by patients as attributed to a workplace injury. There are many studies assessing risk factors for non-specific low back pain. However, studies addressing causality of back pain are deficient.

Purpose

To establish whether there exists a causal relationship between structural injury, low back pain and spinal disability.

Methods

Retrospective analysis of prospectively gathered validated spinal outcome measures [Oswestry disability index (ODI), low back outcome score (LBO), modified somatic perception (MSP), modified Zung depression index (MZD)] between patients with healed high energy thoracolumbar spinal fractures and patients with self-perceived work-related low back pain. Causality was established according to two of Bradford Hill’s criteria of medical causality, temporal and dose–response relationships.

Results

Twenty-three patients with spinal fractures (group 1) of average age 44 years were compared to 19 patients with self-reported back pain in the workplace pursuing claims for compensation (group 2) of average age 48 years. Both groups were comparable in terms of age and sex. The average ODI in group 1 was 28 % (SD 19) compared to 42 % (SD 19) in group 2 (P < 0.05). Similarly, LBOS was 39.7 versus 24.3 (P < 0.05), MSP 4.3 versus 9.3 (P < 0.05) and MZD 20.2 versus 34.8 (P < 0.05) in groups 1 and 2, respectively.

Conclusion

Despite high-energy trauma and significant structural damage to the spine, patients with the high energy injuries had better spinal outcome scores in all measures. There is no ‘dose–response’ relationship between structural injury, low back pain and spinal disability. This is the reverse of what would be anticipated if structural injury was the cause of disability in workplace reported onset of low back pain.

Andersson GBJ (1997). The epidemiology of spinal disorders. In: The adult spine: principles and practice, 2nd edn. Raven Press, New York, p 93–141

Biering-Sørensen F (1983) A prospective study of low back pain in a general population. Occurrence, recurrence and aetiology. Scand J Rehabil Med 15(2):71–79PubMed

Videman T, Battie MC (1999) The influence of occupation on lumbar degeneration. Spine 24(11):1164–1168PubMedCrossRef

Centers for Disease Control and Prevention (CDC) (2010) Proportion of workers who were work-injured and payment by workers’ compensation systems-10 states, 2007. MMWR Morb Mortal Wkly Rep 59(29):897–900

Croft P, Papageorgiou A et al (1994) Low back pain in the community and in hospitals. A report to the Clinical Standards Advisory Group of the Department of Health, Arthritis and Rheumatism Council, Epidemiology Research Unit. University of Manchester, Manchester

Dagenais S, Caro J, Haldeman S (2008) A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J 8:8–20PubMedCrossRef

Croft P, Macfallane GJ, Papageorgiou AC, Thomas E, Silman AJ (1998) Outcome of low back pain in general practice: a prospective study. BMJ 316:1356–1359PubMedCrossRef

Boos N, Kissling R (1999) Diagnostic assessment in lumbar back pain. I. Anamnesis and clinical examination. Praxis (Bern 1994) 88(8):305–313

Borge JA, Leboeuf-Yde C, Lothe J (2001) Prognostic values of physical examination findings in patients with chronic low back pain treated conservatively: a systematic literature review. J Manipulative Physiol Ther 24:292–295PubMedCrossRef

10.

Steenstra IA, Verbeek JH, Heymans MW, Bongers PM (2005) Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: a systematic review of the literature. Occup Environ Med 62(12):851–860PubMedCrossRef

11.

Bois MD, Szpalski M, Donceel P (2009) Patients at risk for long-term sick leave because of low back pain. Spine J 9:350–359PubMedCrossRef

12.

Ramond A, Bouton C, Richard I, Roquelaure Y, Baufreton C, Legrand E, Huez JF (2010) Psychosocial risk factors for chronic low back pain in primary care–a systematic review. Fam Pract. doi:10.1093/fampra/cmq072 PubMed

13.

Gross DP, Battié MC (2005) Predicting timely recovery and recurrence following multidisciplinary rehabilitation in patients with compensated low back pain. Spine 30(2):235–240PubMedCrossRef

14.

Côté P, Baldwin ML, Johnson WG, Frank JW, Butler RJ (2008) Patterns of sick-leave and health outcomes in injured workers with back pain. Eur Spine J 17(4):484–493PubMedCrossRef

15.

Rasmussen C, Leboeuf-Yde C, Hestbaek L, Manniche C (2008) Poor outcome in patients with spine-related leg or arm pain who are involved in compensation claims: a prospective study of patients in the secondary care sector. Scand J Rheumatol 37(6):462–468PubMedCrossRef

16.

Tropiano P, Huang RC, Louis CA, Poitout DG, Louis RP (2003) Functional and radiographic outcome of thoracolumbar and lumbar burst fractures managed by closed orthopaedic reduction and casting. Spine 28(21):2459–2465PubMedCrossRef

17.

Seybold EA, Sweeney CA, Fredrickson BE, Warhold LG, Bernini PM (1999) Functional outcome of low lumbar burst fractures. A multicenter review of operative and nonoperative treatment of L3–L5. Spine 24(20):2154–2161PubMedCrossRef

18.

McLain RF (2004) Functional outcomes after surgery for spinal fractures: return to work and activity. Spine 29(4):470–477PubMedCrossRef

19.

Wood K, Buttermann G, Mehbod A, Garvey T, Jhanjee R, Sechriest V (2003) Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit: a prospective, randomized study. J Bone Joint Surg Am 85:773–781PubMedCrossRef

20.

Wai EK, Roffey DM, Bishop P, Kwon BK, Dagenais S (2010) Causal assessment of occupational lifting and low back pain: results of a systematic review. Spine J 10:554–566PubMedCrossRef

21.

Mason S, Wardrope J, Turpin G, Rowlands A (2002) Outcomes after injury: a comparison of workplace and nonworkplace injury. J Trauma 53(1):98–103PubMedCrossRef

22.

Austin Bradford Hill (1965) The environment and disease: association or causation? Proc R Soc Med 58:295–300

23.

Turner JA, Franklin G, Fulton-Kehoe D, Egan K, Wickizer TM, Lymp JF, Sheppard L, Kaufman JD (2004) Prediction of chronic disability in work-related musculoskeletal disorders: a prospective, population-based study. BMC Musculoskelet Disord 5:14PubMedCrossRef

24.

Giannoudis PV, Mehta SS, Tsiridis E (2007) Incidence and outcome of whiplash injury after multiple trauma. Spine 32(7):776–781PubMedCrossRef

25.

Webster BS, Cifuentes M (2010) Relationship of early magnetic resonance imaging for work-related acute low back pain with disability and medical utilization outcomes. J Occup Environ Med 52(9):900–907PubMedCrossRef

Title: Dose response and structural injury in the disability of spinal injury
Authors: Mohammed Shakil Patel
Philip Sell
Publication date: 01-03-2013
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue 3/2013
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-012-2498-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Dose response and structural injury in the disability of spinal injury

Abstract

Introduction

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2013

Radiological study on disc degeneration of thoracolumbar burst fractures treated by percutaneous pedicle screw fixation

A study investigating the validity of modified Tokuhashi score to decide surgical intervention in patients with metastatic spinal cancer

Computer-assisted fluoroscopic navigation of percutaneous spinal interventions

Treatment of spinal epidural compression due to hematological malignancies: a single institution’s retrospective experience

Aneurysmal bone cysts of the spine

Surgery and survival outcomes of 22 patients with epidural spinal cord compression caused by thyroid tumor spinal metastases