Ali Shakir

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.

Low-back pain in transfemoral amputees: is there a correlation with static or dynamic leg-length discrepancy?

Morgenroth DC, Shakir A, Orendurff MS, Czerniecki JM: Low-back pain in transfemoral amputees: Is there a correlation with static or dynamic leg-length discrepancy? Am J Phys Med Rehabil 2009;88:108–113. Objective:Low-back pain (LBP) is an important cause of secondary disability in transfemoral amputees (TFA). The correction of leg-length discrepancy (LLD) is a common clinical approach to the treatment of LBP in this population. The aim of our study is to assess the relationship of static and dynamic LLD and LBP in a sample TFA population. Design:Nine TFA with LBP and eight TFA without LBP were studied. Static leg length was measured with subjects standing in a self-selected comfortable position. Dynamic leg length was measured during the single-limb support and double-limb support phases of the gait cycle. Results:There were no statistically significant differences between the pain and no pain groups in terms of static LLD (P = 1.0; 95% confidence interval, −6.8 to 6.6 mm); dynamic LLD during single-limb support (P = 0.3; 95% confidence interval, −27.3 to 7.3 mm); dynamic LLD during double-limb support with either the prosthetic limb leading (P = 0.3; 95% confidence interval, −4.0 to 12.2 mm) or the intact foot leading (P = 0.8, 95% confidence interval, −6.4 to 7.8 mm). Conclusions:This study calls into question whether LLD plays a significant role in persistence of LBP in TFA. Further study of the effects of LLD and its possible relationship to causation of LBP in amputees is needed.

Poster 152: Sagittal plane biomechanics and low back pain in transfemoral amputees.1

Objectives: To document the extent of static lumbar lordosis and dynamic lumbar spine motion in the sagittal plane in transfemoral amputees and to determine whether excessive lumbar lordosis and excessive sagittal plane spine motion are related to low back pain (LBP) in transfemoral amputees. Design: A cross-sectional observational study. Setting: Motion analysis laboratory at a Veterans Affairs tertiary care facility. Participants: 6 ambulatory transfemoral amputees with a history of significant chronic LBP (CLBP) beginning after amputation and 3 ambulatory transfemoral amputees without history of CLBP since amputation. Interventions: Not applicable. Main Outcome Measures: L1-S1 Cobb angle from a lateral upright radiograph. Peak lumbar sagittal plane flexion and extension measured by a video-based motion analysis system. Results: The mean L1-S1 Cobb angle ± SD (range) were 62°±10° (44°–77°) for transfemoral amputees with LBP and 58°±3° (54°–61°) for transfemoral amputees without LBP. The mean maximum degrees of flexion (range) were 4.2°±5.9° (−8.0° to 13.7°) for transfemoral amputees with LBP and 3.0°±3.4° (−2.7° to 8.8°) for transfemoral amputees without LBP. The mean maximum degrees of extension (range) were −5.7°±6.4° (−21.0° to 2.3°) for transfemoral amputees with LBP and −5.9°±4.1° (−12.1° to 1.0°) for transfemoral amputees without LBP. Conclusions: The L1-S1 Cobb angle showed a significant relationship with LBP in transfemoral amputees (P<.0313). The most extreme L1-S1 Cobb angles were seen in transfemoral amputees with LBP. There was no difference between the groups in either maximum lumbar flexion or extension (P<0.3). From this data, static lumbar angles appear to be more related to LBP than the sagittal flexion and extension range of dynamic lumbar motion during gait; perhaps it is not the extremes of sagittal plane lumbar motion that place this population at risk. However, type II error cannot be excluded.

The relationship between lumbar lordosis angle and low back pain in individuals with transfemoral amputation

Background: Low back pain is a common secondary disabling condition in the transfemoral amputee population. Transfemoral amputees are at risk of excessive lumbar lordosis; it has been suggested that increased lumbar lordosis may be associated with low back pain. However, the relationship between lumbar lordosis angle and low back pain has not yet been studied in this population. Objective: To determine whether the extent of lumbar lordosis is associated with low back pain in transfemoral amputees. Study design: Case–control observational study. Methods: Participants included eight transfemoral amputees without low back pain and nine transfemoral amputees with low back pain. Etiology of amputation was primarily trauma. All participants underwent lateral view radiographs of the lumbar spine, from which lumbar lordosis angle and sacral inclination angle were measured. Results: Lumbar lordosis angle mean ± standard deviation was 46.1° ± 12.4° in participants with low back pain and 51.0° ± 12.6° in those without. Sacral inclination angle mean ± standard deviation was 38.3° ± 8.7° in participants with low back pain and 39.1° ± 7.5° in those without. There was no significant difference in lumbar lordosis angle or sacral inclination angle between participants with and without low back pain. Conclusion: This study suggests that increased lumbar lordosis angle and sacral inclination angle are not significantly associated with low back pain in transfemoral amputees of a primarily traumatic etiology. Clinical relevance Low back pain (LBP) is a common, disabling condition in transfemoral amputees. In the clinical setting, increased lumbar lordosis is implicated in LBP. This study does not support an association between increased lumbar lordosis and LBP; further study is needed to understand the increased prevalence of LBP in this population.