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European Spine Journal

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01-05-2018 | Original Article

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

Authors: Ashutosh B. Sabnis, Uphar Chamoli, Ashish D. Diwan

Published in: European Spine Journal | Issue 5/2018

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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Title: Is L5–S1 motion segment different from the rest? A radiographic kinematic assessment of 72 patients with chronic low back pain
Authors: Ashutosh B. Sabnis
Uphar Chamoli
Ashish D. Diwan
Publication date: 01-05-2018
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 5/2018
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-017-5400-4

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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