The Study: Relationship between low back pain and lumbar sagittal alignment after lumbar fusion
a. First, I only had the abstract of this article to read. The full text article was in Chinese and my Mandarin is non-existent. So keep that in mind.
b. This is a retrospective evaluation which looked at the relationship between pain and the sagittal alignment of the lumbar spine in subjects who had undergone lumbar fusion.
c. They used 182 consecutive patients.
d. These patients had all received posterior lumbar interbody fusion in response to degenerative lumbar spine diseases.
e. They were followed for two years.
f. In the follow up period the patients received standing lumbar x-rays and their lumbar lordoses were measured.
g. Pain levels were evaluated using visual analog scales and Oswestry disability indexes.
h. The authors concluded, “There is a close relationship between back pain after fusion and loss of lumbar sagittal lordosis. And reconstruction of lumbar lordosis should be one important goal for lumbar fusion.”
In these fusion patients the authors found a close relationship between low back pain and loss of lumbar lordosis and recommend that care should be taken by the surgeons to restore the sagittal curves in order to improve outcomes.
It seems to come back to one point over and over. Structures that are altered from optimum in relation to gravity tend to have more problems. In spines we need structural alignment and normal function. I don’t see how you have one without the other. Of course, function can never be normal following fusion surgery. Structural misalignment seems to exacerbate problems on top of that. Every case brings a lot of things for the doctor to consider. One of these (especially for chiropractors) should be addressing any significant loss of the lumbar lordosis.
Reviewer: Roger Coleman DC
Editor: Mark R. Payne DC
Reference: Hai Y, Zhao H, Shao N, Lu SB, Yang JC, Liu YZ. Relationship between low back pain and lumbar sagittal alignment after lumbar fusion. Zhonghua Yi Xue Za Zhi. 2013 Apr 16;93(15):1129-32
Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/23902879