Efficacy of flexion and extension treatments incorporating braces for low-back pain patients with retrodisplacement, spondylolisthesis, or normal sagittal translation

Kevin F. Spratt, James Neil Weinstein, Joyce Woody, Hutha Sayre*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

60 Scopus citations

Abstract

Hadlograpfilc instability seemingly enjoys the status of e wsil-dsfined clinical syndrome, The concept is wldsly used, nnci spsclfic JreatrtiantiS usually spinal fusion, are routinely performed based un the diagnosis. The minimum standards necessary to rcstafcNsh radiographic instability Hs a legilimHte clinical syndrome have not b«en established, however. The primary purpose of this study was to determine fF treatment involving bracing, a*erei. 4e. and adueatloh Controlling Hither linxinr or extension postures, would result in a distinctive pattern of favorable or unfavorable results, depend ng on the type of radiographic In stability Uatrodlsp ucsmeni or 5 pondy I si isthesis), Fifty-Bix patients meet'ng strict study inclusion Hnd radiographic evaluation criteria were 3S* signed to s bracing insentient (flexion, extension, placebo- control) Hceordsng tu a randomization scheme, designed to ensure equal fapresentation of translation categories (retro, normal, spondy) across treatment groups, and assessad At admissinn Hnd 1-month fo-llow-up, The sample was relatively evenly divided between man (46%) and worn on (54%), and by ago, Translation ciagaificallon wbs related to tn>|h sender and age, with men more likely classified as retro end women more likely spondy, and patients In their 20s having lower Incident of spondy and higher Incldanco of normal; ranslalii:n. TranaEation clarification was not related to se'ected in- Hiqes of Inw-tiHnk pain: history. Rrace treatments were not shown to reduce patient range or motion or lessen trunk Strong til, A significant treatment by time interaction for Hp modified pain interference [Vft3| scale indicated improvement for patients in extension compered with petipnts in flenion end control-placebo treatments. In conjunction with no significant three-way Interaction be From the *Spine Diagnostic and Treatment Center, Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa and the fLouisville Orthopedic Clinic, Louisville, Kentucky. Supported in part by NIH grant # A R 34344-03 and Camp International, Inc (J. Weinstein, principle investigator). Accepted for publication May 11, 1992. IwCu-ri IrualiTiEfnlj translation classification, and time, It wAE hypothBEizEd that radiographic instability might more appropriately be considered e corroborative sign of advanced discogenie problems. Improvement in exters'on treatment, regardless of tha type of radiograph la abnormity, suggests lhatthe treating clinician might consider extension treatment for chronic lowSSsck pain petierts, Causes and Implications for the failure of ihis sttrdy to provide support for considering radiographic instability as u clinical syndrome are considered anc future directions for Shis area pf research auggasted.

Original languageEnglish (US)
Pages (from-to)1839-1849
Number of pages11
JournalSpine
Volume18
Issue number13
DOIs
StatePublished - Oct 1993

Keywords

  • Bracing
  • Instability!
  • Low-back pain
  • Retrodisnlflcement
  • Spondylolisthesis

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

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