The Relationship Between Lumbar Spine Kinematics during Gait and Low-Back Pain in Transfemoral Amputees

Morgenroth DC, Orendurff MS, Shakir A, Segal A, Shofer J, Czerniecki JM: The relationship between lumbar spine kinematics during gait and low-back pain in transfemoral amputees. Objective:Low-back pain is an important cause of secondary disability in transfemoral amputees. The primary aim of our study is to assess the differences in lumbar spine kinematics during gait between transfemoral amputees with and without low-back pain. Design:Lumbar spine kinematics in three planes were measured when the subjects walked in a motion analysis laboratory. Nine transfemoral amputees with low-back pain, eight transfemoral amputees without low-back pain, and six healthy, nonamputee subjects participated. Results:The Amputee Pain and Amputee No Pain groups were essentially the same in terms of all demographic and potentially confounding variable measures. Transfemoral amputees with low-back pain showed greater transverse plane rotational excursion in their lumbar spine during walking when compared with transfemoral amputees without low-back pain (P = 0.029; effect size = 1.03). There were no significant differences in sagittal or coronal plane lumbar spine excursions during walking between these two groups. Conclusions:Although our study design does not allow for proving causation, increased transverse plane rotation has been associated with intervertebral disc degeneration, suggesting that increased transverse plane rotation secondary to walking with a prosthetic limb may be a causative factor in the etiology of low-back pain in transfemoral amputees. Identifying differences in lumbar motion can lead to potential preventative and therapeutic intervention strategies.

[1]  J G Buckley,et al.  Chronic low back pain in traumatic lower limb amputees , 2005, Clinical rehabilitation.

[2]  E. Does,et al.  The occurrence and inter-rater reliability of myofascial trigger points in the quadratus lumborum and gluteus medius: A prospective study in non-specific low back pain patients and controls in general practice , 1994, Pain.

[3]  C. Sherbourne,et al.  The MOS 36-Item Short-Form Health Survey (SF-36) , 1992 .

[4]  D W Bates,et al.  Can comorbidity be measured by questionnaire rather than medical record review? , 1996, Medical care.

[5]  Pelvic motion in trans-femoral amputees in the frontal and transverse plane before and after special gait re-education , 2003, Prosthetics and orthotics international.

[6]  G. De Backer,et al.  The Impact of Psychosocial Factors on Low Back Pain: Longitudinal Results From the Belstress Study , 2007, Spine.

[7]  L. Radloff.  The CES-D Scale , 1977 .

[8]  Winfried Banzer,et al.  Influences of Nonspecific Low Back Pain on Three-Dimensional Lumbar Spine Kinematics in Locomotion , 2001, Spine.

[9]  Michael S Orendurff,et al.  Low-Back Pain in Transfemoral Amputees: Is There a Correlation with Static or Dynamic Leg-Length Discrepancy? , 2009, American journal of physical medicine & rehabilitation.

[10]  A. M. Purves,et al.  The Chronic Pain Grade questionnaire: validation and reliability in postal research , 1997, Pain.

[11]  E. van der Does,et al.  The occurrence and inter-rater reliability of myofascial trigger points in the quadratus lumborum and gluteus medius: a prospective study in non-specific low back pain patients and controls in general practice. , 1994, Pain.

[12]  J. Czerniecki,et al.  The prevalence of knee pain and symptomatic knee osteoarthritis among veteran traumatic amputees and nonamputees. , 2005, Archives of physical medicine and rehabilitation.

[13]  J. Czerniecki,et al.  Mechanical work adaptations of above-knee amputee ambulation. , 1996, Archives of physical medicine and rehabilitation.

[14]  A Cappozzo,et al.  Angular displacements in the upper body of AK amputees during level walking , 1982, Prosthetics and orthotics international.

[15]  H. Day,et al.  The assessment and description of amputee activity , 1981, Prosthetics and orthotics international.

[16]  Stefania Fatone,et al.  A Kinematic Model to Assess Spinal Motion During Walking , 2006, Spine.

[17]  H. J. de Jongh,et al.  Prosthetic gait of unilateral transfemoral amputees: a kinematic study. , 1995, Archives of physical medicine and rehabilitation.

[18]  J. Czerniecki,et al.  Rehabilitation in limb deficiency. 1. Gait and motion analysis. , 1996, Archives of physical medicine and rehabilitation.

[19]  M. Krismer,et al.  The Contribution of Anulus Fibers to Torque Resistance , 1996, Spine.

[20]  G. Andersson.  Epidemiological features of chronic low-back pain , 1999, The Lancet.

[21]  Analysis of torso movement of trans-femoral amputees during level walking , 1997, Prosthetics and orthotics international.

[22]  E. Karaharju,et al.  Immunohistochemical Demonstration of Nociceptors in the Ligamentous Structures of the Lumbar Spine , 1985, Spine.

[23]  J. Seidell,et al.  Epidemiology of obesity. , 2002, Seminars in vascular medicine.

[24]  D A Boone,et al.  Phantom limb, residual limb, and back pain after lower extremity amputations. , 1999, Clinical orthopaedics and related research.

[25]  A. Patla,et al.  Low back three-dimensional joint forces, kinematics, and kinetics during walking. , 1999, Clinical biomechanics.

[26]  Pascale Fodé,et al.  Three-dimensional motions of trunk and pelvis during transfemoral amputee gait. , 2008, Archives of physical medicine and rehabilitation.

[27]  J. Czerniecki,et al.  Chronic phantom sensations, phantom pain, residual limb pain, and other regional pain after lower limb amputation. , 2000, Archives of physical medicine and rehabilitation.

[28]  M. Roland,et al.  A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. , 1983, Spine.

[29]  M. Hellström,et al.  Disc Degeneration and Associated Abnormalities of the Spine in Elite Gymnasts: A Magnetic Resonance Imaging Study , 1991, Spine.

[30]  Philip Rowe,et al.  Three dimensional, lumbar spinal kinematics during gait, following mild musculo-skeletal low back pain in nurses , 1996 .

[31]  D G Smith,et al.  Back pain as a secondary disability in persons with lower limb amputations. , 2001, Archives of physical medicine and rehabilitation.

[32]  G B Andersson,et al.  The Effect of Disc Degeneration and Facet Joint Osteoarthritis on the Segmental Flexibility of the Lumbar Spine , 2000, Spine.

[33]  A. Leclerc,et al.  Biomechanical strains and low back disorders: quantifying the effects of the number of years of exposure on various types of pain , 2007, Occupational and Environmental Medicine.

[34]  L. Claes,et al.  Intradiscal Pressure, Shear Strain, and Fiber Strain in the Intervertebral Disc Under Combined Loading , 2007, Spine.

[35]  Roongtiwa Vachalathiti,et al.  Age, gender and speed effects on spinal kinematics during walking , 1997 .

[36]  R A Deyo,et al.  Lifestyle and Low-Back Pain: The Influence of Smoking and Obesity , 1989, Spine.