Correlative Study on Abnormal Roentgenological Findings of the Spine and the Incidence of Low Back Pain / 대한정형외과학회잡지

ABSTRACT

The etiologic factors causing low back pain are numerous and variable. Orthopaedic sugreons tend to focus attention to any defects of structural and functional origins such as pine, discs and facet joints. Clinically, however, the fact remains that not all abnormal findings produce back pain and vice vera. Among the many modalities of investigation to determine the etiology of back pain, plain X-ray of the lumbosacral spine is the single most important acreening method. In addition to antero-posterior, lateral and oblique views, stress view of the spine gives certain clue to predict the disc degeneration. The X-ray findings of a total of 503 patients with low back pain (the study group). admitted during the year of 1977 to the Department of Orthopaedic Surgery, National Medical Center, were reviewed and compared with the control group of 100 patients without relevance to back pain (the control group). Our intention was to explore the relationship between the abnormal findings of plain X-rays and occurence of back pain. and to further entrance the diagnostic value of the spine. The study group of 503 patients (86 cases of which were operated on) were diagnosed not only by routine plain X-rays but also by contrast myelography and tomography in addition to detailed physical examination. Following observations were made 1. The sex was nearly equally distributed in the atudy group of 503 patients. The age ranged from the second to the eighth decade, dominant group being the third to fifth decades. 2. The causes of the low back pain were herniated disc, spondylosis, spondylolysis, and infection, in that order. 119 patients (23.7%) out of the 503 showed no roentgenologicaI abnormal findings. 3. 384 cases out of the 503 revealed abnormal findings, mainly congenital or developmental and degenerative changes in that order. 4. In a comparative study with the control group, congenital or developmental anomalies and degenerative changes were not related to low back pain. Disc. space narrowing, supposed to be valuable in establishing the diagnosis of low back pain was present in 26% of the cases in study group and in 11% in the control group. 5. The age incidence of the low back pain with congenital or developmental anomalies was mainly in th second and third decades, while that of disc space narrowing was in the third to fifth decade. The degenerative changes of the spine appeared after the fourth decade. 6. Transitional vertebra and tropism are supposed to plsy a role on the degenerative change of the spine. 7. The stress study of the spine had some benifit it the diagnosis of disc degeneration. The mobility of the L4-5 lesion with low back pain was increased to mean 15.1 and standard deviation 3.7, in comparison to the mean 12.3 and standard deviation 3.7 in the control group.