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Association between Prognosis of Low Back Pain Patients with Severity of Abnormal Lumbar Lordosis

한방병원에 입원한 요통 환자의 요추 전만각, 요천각 변화의 심각도에 따른 예후 분석 연구

  • Han, Su-Bin (Department of Korean Medicine Rehabilitation, Jaseng Hospital of Korean Medicine) ;
  • Kim, Eun-San (Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation) ;
  • Kim, Hyo-Jun (Department of Korean Medicine Rehabilitation, Daejeon Jaseng Hospital of Korean Medicine) ;
  • Jo, Hoo-In (Department of Acupuncture and Moxibustion Medicine, Jaseng Hospital of Korean Medicine) ;
  • Kim, Mi-hye (Department of Korean Medicine Rehabilitation, Jaseng Hospital of Korean Medicine) ;
  • Lee, Nam-Woo (Department of Korean Medicine Rehabilitation, Jaseng Hospital of Korean Medicine) ;
  • Han, Jeong-Hun (Department of Korean Medicine Rehabilitation, Jaseng Hospital of Korean Medicine) ;
  • Park, Byung-Hak (Department of Korean Medicine Rehabilitation, Jaseng Hospital of Korean Medicine) ;
  • Son, Jae-Min (Department of Korean Medicine Rehabilitation, Jaseng Hospital of Korean Medicine) ;
  • Kang, Do-Hyeon (Department of Korean Medicine Rehabilitation, Jaseng Hospital of Korean Medicine) ;
  • Min, Tae-Woon (Department of Korean Medicine Rehabilitation, Jaseng Hospital of Korean Medicine) ;
  • Lee, Hyun-Jun (Department of Korean Medicine Rehabilitation, Jaseng Hospital of Korean Medicine) ;
  • Ahn, Jae-Seo (Department of Korean Medicine Rehabilitation, Jaseng Hospital of Korean Medicine) ;
  • Lee, Han-Sol (Department of Korean Medicine Rehabilitation, Jaseng Hospital of Korean Medicine)
  • 한수빈 (자생한방병원 한방재활의학과) ;
  • 김은산 (자생의료재단 척추관절연구소) ;
  • 김효준 (대전자생한방병원 한방재활의학과) ;
  • 조후인 (자생한방병원 침구과) ;
  • 김미혜 (자생한방병원 한방재활의학과) ;
  • 이남우 (자생한방병원 한방재활의학과) ;
  • 한정훈 (자생한방병원 한방재활의학과) ;
  • 박병학 (자생한방병원 한방재활의학과) ;
  • 손재민 (자생한방병원 한방재활의학과) ;
  • 강도현 (자생한방병원 한방재활의학과) ;
  • 민태운 (자생한방병원 한방재활의학과) ;
  • 이현준 (자생한방병원 한방재활의학과) ;
  • 안재서 (자생한방병원 한방재활의학과) ;
  • 이한솔 (자생한방병원 한방재활의학과)
  • Received : 2020.09.17
  • Accepted : 2020.10.07
  • Published : 2020.10.31

Abstract

Objectives To analyze the prognosis of patients with low back pain according to the severity of abnormal lumbar lordotic angle and Ferguson's angle. Methods Data from electronic medical record of a total of 199 patients hospitalized in Korean medicine hospital were analyzed. With the sagittal view of lumbar spine X-ray, lumbar lordotic angle was defined as the angle between the superior endplate of L1 with the inferior endplate of L5. Ferguson's angle was defined as the angle between the superior surfaces of the sacral with a horizontal line. 'Measure Cobb's Angle Tool' of 'INFINITT PACS' was used to measure both angles. Lumbar lordotic angle and Ferguson's angle were subdivided into five sections. The number of days from onset and the duration of hospitalization were analyzed in each section. Results Severe hypolordotic lumbar lordotic angle group were found to have longer medical history and hospitalization duration than the control group. The ratio of long-term hospitalization (over 15 days) and chronic medical history (over 180 days) of patients with severe hypolordotic Ferguson's angle were significantly higher than the control group. The ratio of patients with chronic medical history (over 180 days) was significantly higher in severe hyperlordotic Ferguson's angle group than the control group. Conclusions Severe hypolordotic lumbar lordotic angle was related to patient's prognosis. Both severe hyperlordotic and severe hypolordotic Ferguson's angle were found to be related to patient's prognosis. However, a moderate loss of lumbar lordotic angle and Ferguson's angle was not related to prognosis of low back pain patients.

Keywords

References

  1. Lee GM. Presumption of low back pain and symptoms for surgical treatment. The Journal of Korean Acupuncture & Moxibustoin Society. 2001;18(2):237-44.
  2. Pengel LH, Herbert RD, Maher CG, Refshauge KM. Acute low back pain: systematic review of its prognosis. BMJ (Clinical research ed). 2003;327(7410):323. https://doi.org/10.1136/bmj.327.7410.323
  3. Balague F, Mannion AF, Pellise F, Cedraschi C. Clinical update: low back pain. Lancet (London, England). 2007;369(9563):726-8. https://doi.org/10.1016/S0140-6736(07)60340-7
  4. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G; COST B13 Working Group on Guidelines for Chronic Low Back Pain. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. European Spine Journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2006;15 Suppl 2(Suppl 2):S192-300. https://doi.org/10.1007/s00586-006-1072-1
  5. Buchbinder R, Blyth FM, March LM, Brooks P, Woolf AD, Hoy DG. Placing the global burden of low back pain in context. Best Practice & Research Clinical Rheumatology. 2013;27(5):575-89. https://doi.org/10.1016/j.berh.2013.10.007
  6. Lee KJ, Oh MS, Lee EJ, Shin BC, Hwang EH, Kim SJ, Cha YY, Ko YS, Song YK. Trends of Korean medicine conservative treatment using low back pain patients registry data: analysis of medical records of 7 Korean medical hospital. J Korean Med Rehabil. 2019;29(3):87-101. https://doi.org/10.18325/jkmr.2019.29.3.87
  7. Kim GT. Diagnosis and treatment for patients with lumbago. Korean Journal of Family Practice. 1997;18(2):106-25.
  8. Farfan HF. The biomechanical advantage of lordosis and hip extension for upright activity. Man as compared with other anthropoids. Spine (Phila Pa 1976). 1978;3(4):336-42. https://doi.org/10.1097/00007632-197812000-00006
  9. Aspden RM. The spine as an arch. A new mathematical model. Spine (Phila Pa 1976). 1989;14(3):266-74. https://doi.org/10.1097/00007632-198903000-00005
  10. Christie HJ, Kumar S, Warren SA. Postural aberrations in low back pain. Archives of Physical Medicine and Rehabilitation. 1995;76(3):218-24. https://doi.org/10.1016/S0003-9993(95)80604-0
  11. Ohlen G, Wredmark T, Spangfort E. Spinal sagittal configuration and mobility related to low-back pain in the female gymnast. Spine. 1989;14(8):847-50. https://doi.org/10.1097/00007632-198908000-00013
  12. Korovessis P, Stamatakis M, Baikousis A. Segmental roentgenographic analysis of vertebral inclination on sagittal plane in asymptomatic versus chronic low back pain patients. Journal of Spinal Disorders. 1999;12(2):131-7.
  13. Hansson T, Bigos S, Beecher P, Wortley M. The lumbar lordosis in acute and chronic low-back pain. Spine. 1985;10(2):154-5. https://doi.org/10.1097/00007632-198503000-00008
  14. Pope MH, Bevins T, Wilder DG, Frymoyer JW. The relationship between anthropometric, postural, muscular, and mobility characteristics of males ages 18-55. Spine. 1985;10(7):644-8. https://doi.org/10.1097/00007632-198509000-00009
  15. Itoi E. Roentgenographic analysis of posture in spinal osteoporotics. Spine. 1991;16(7):750-6. https://doi.org/10.1097/00007632-199107000-00011
  16. Jackson RP, McManus AC. Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study. Spine. 1994;19(14):1611-8. https://doi.org/10.1097/00007632-199407001-00010
  17. Adams MA, Mannion AF, Dolan P. Personal risk factors for first-time low back pain. Spine. 1999;24(23):2497-505. https://doi.org/10.1097/00007632-199912010-00012
  18. Chun SW, Lim CY, Kim K, Hwang J, Chung SG. The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis. The Spine Journal: Official Journal of the North American Spine Society. 2017;17(8):1180-91. https://doi.org/10.1016/j.spinee.2017.04.034
  19. Sadler SG, Spink MJ, Ho A, De Jonge XJ, Chuter VH. Restriction in lateral bending range of motion, lumbar lordosis, and hamstring flexibility predicts the development of low back pain: a systematic review of prospective cohort studies. BMC Musculoskeletal Disorders. 2017;18(1):179. https://doi.org/10.1186/s12891-017-1534-0
  20. Lee JW, Chung JH, Kwon OC, Rhee BC. Radiologic study on measurement of lumbosacral angle in backache patients. J Korean Radiol Soc.1982;18(2):371-7. https://doi.org/10.3348/jkrs.1982.18.2.371
  21. Koh DH, Hong SS, Lee JH, Jung SY, Shin JS. Statistical study of the Ferguson's angle, lumbar gravity line and lumbar lordotic angle in HIVD patients. The Journal of Korea CHUNA Manual Medicine for Spine & Nerves. 2007;2(2):17-31.
  22. Jung SY, Park YH, Keum DH, Lee MJ, Cho YC. Statistical study of the Ferguson angle and lum bar gravity line in acute and chronic lum bago patients. J Oriental Rehab Med. 2003;13(1):119-29.
  23. Jeong DU Yeo KC, Yoon IA, Kang HS, Moon SI. A clinical study on correlation between cervical, lumbar lordosis and low back pain. The Journal of Korean Acupuncture & Moxibustoin Society. 2009;26(2):15-23.
  24. Choi BM, Yi JM, Kim HS. A study on correlation between power of trunk flexors, extensors and lumbar lordotic angle in normal adults. The Journal of Korea CHUNA Manual Medicine for Spine and Nerves. 2012;7(2):39-52.
  25. Fernand R, Fox DE. Evaluation of lumbar lordosis. A prospective and retrospective study. Spine. 1985;10(9):799-803. https://doi.org/10.1097/00007632-198511000-00003
  26. Kang ES, Han DY, Jahng JS, Ahn HY, Chung IH. Statistical observation of Ferguson's angle of healthy Korean adults. The Journal of the Korean Orthopaedic Association. 1967;2(1):67-73. https://doi.org/10.4055/jkoa.1967.2.1.67
  27. Kim NY, Kang JH, Lee H. Effect of work environment and low back pain on the structural and muscle strength changes in lumbar spine. The Journal of Korean Acupuncture & Moxibustoin Society. 2010;27(3):93-104.
  28. Williams SA, Russo GA. Evolution of the hominoid vertebral column: The long and the short of it. Evol Anthropol. 2015;24(1):15-32. https://doi.org/10.1002/evan.21437
  29. Rajnics P, Templier A, Skalli W, Lavaste F, Illes T. The association of sagittal spinal and pelvic parameters in asymptomatic persons and patients with isthmic spondylolisthesis. J Spinal Disord Tech. 2002;15(1):24-30. https://doi.org/10.1097/00024720-200202000-00004
  30. Lazennec JY, Ramare S, Arafati N, Laudet CG, Gorin M, Roger B, Hansen S, Saillant G, Maurs L, Trabelsi R. Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J. 2000;9(1):47-55. https://doi.org/10.1007/s005860050008
  31. Keller TS, Colloca CJ, Harrison DE, Harrison DD, Janik TJ. Influence of spine morphology on intervertebral disc loads and stresses in asymptomatic adults: implications for the ideal spine. Spine J. 2005;5(3):297-309. https://doi.org/10.1016/j.spinee.2004.10.050
  32. Heo J. DongEuiBoGam. 1st rev. Seoul:Min Joong Seo Won. 1993:446-53.
  33. Korean Medical Association. How to write and issue medical certificates. 2015:63.
  34. Lee TK. The effect of Chuna treatment on the low back pain & radiating pain. Exercise Prescription & Rehabilitation special study, Department of Graduate School of Sports Industry. 2001:1-52.
  35. Fatemi R, Javid M, Najafabadi EM. Effects of William training on lumbosacral muscles function, lumbar curve and pain. J Back Musculoskelet Rehabil. 2015;28(3):591-7. https://doi.org/10.3233/BMR-150585
  36. Malai S, Pichaiyongwongdee S, Sakulsriprasert P. Immediate effect of hold-relax stretching of iliopsoas muscle on transversus abdominis muscle activation in chronic non-specific low back pain with lumbar hyperlordosis. J Med Assoc Thai. 2015;98 Suppl 5:S6-11.