The Value of Video Rasterstereography in the Detection of Alterations in Posture as a Marker of Pain Relief after Targeted Infiltrations of the Lumbar Spine

Abstract

Background Targeted infiltrations to the lumbar spine are used to identify the correct scope for surgery in patients with chronic lumbar back pain (CLBP) and multi-segmental pathologies, where radiologic imaging and clinical presentation do not match. Conclusions from that method have so far been based on individual statements of pain relief. The main principle for the infiltrations is the assumption that by locally administering an analgesic agent to possible surgical target areas, the effect of surgery can be temporarily simulated. The aim was to investigate the use of rasterstereographic posture measurements to substantiate reported pain reduction after infiltrations.

Methods In this case-control study (Level II), rasterstereography was performed on 57 patients and 28 reference subjects to evaluate changes in posture during 1 week of injections under fluoroscopic guidance and correlated with changes in the Numeric Pain Rating Scale (NRS). Statistical analysis was performed with SPSS (α = .05, two-sided) and presented in the form of box, scatter, and Bland-Altman plots.

Results and Conclusion The CLBP patientsʼ trunk inclination (median 6°) and absolute lateral tilt were significantly increased (p < .01 each) compared to the reference group. No significant difference was observed for trunk length, kyphotic/lordotic angle, or lateral deviation. During infiltration, no significant difference in posture could be observed. A subgroup analysis of patients reporting the highest pain improvement indicated no significant difference. No correlation was observed with pain improvement reported by the patients during injections. Subsequent rasterstereography does not seem to be able to verify results of injections in the diagnostics of lumbar spine pathologies, as patientsʼ reported pain relief does not correlate with a relevant alteration in posture. The short-term effect of the targeted infiltrations may not suffice to change false posture being developed over years.

Zusammenfassung

Hintergrund Gezielte Infiltrationen der Lendenwirbelsäule im Rahmen einer Stufendiagnostik werden verwendet, um den Operationsumfang bei Patienten mit chronischen Rückenschmerzen (CLBP) und multisegmentalen Pathologien zu ermitteln, bei denen radiologische Bildgebung und klinische Darstellung nicht vollends übereinstimmen. Schlussfolgerungen aus dieser Methode basierten bisher auf individuellen Aussagen zur Schmerzlinderung. Das Hauptprinzip ist hierbei die Annahme, dass durch die lokale Verabreichung eines Analgetikums, an mögliche chirurgische Zielbereiche, der Effekt einer Operation vorübergehend simuliert werden kann. Studienziel war es, die rasterstereografische Haltungsmessungen zu untersuchen, um die patientenseitig angegebene Schmerzreduktion zu objektivieren.

Material und Methoden In dieser Fall-Kontroll-Studie wurde bei 57 Patienten und 28 Referenzpersonen eine Rasterstereografie durchgeführt, um Veränderungen der Körperhaltung während einer stationären Stufendiagnostik über den Zeitraum einer Woche zu bewerten und mit Veränderungen der numerischen Schmerzbewertungsskala (NRS) zu korrelieren. Die statistische Analyse wurde mit SPSS (α = 0,05, zweiseitig) durchgeführt und in Form von Box-, Scatter- und Bland-Altman-Diagrammen dargestellt.

Ergebnisse Die Rumpfneigung der CLBP-Patienten (Median 6°) und die absolute Seitenneigung waren im Vergleich zur Referenzgruppe signifikant erhöht (jeweils p < 0,01). Für Rumpflänge, kyphotischen/lordotischen Winkel oder laterale Abweichung wurde kein signifikanter Unterschied beobachtet. Während der Infiltration konnten keine signifikanten Haltungsunterschiede festgestellt werden. Eine Subgruppenanalyse der Patienten mit der höchsten Schmerzverbesserung ergab keinen signifikanten Unterschied. Es wurde keine Korrelation mit der von den Patienten während der Injektionen berichteten Schmerzverbesserung beobachtet.

Schlussfolgerung Die Rasterstereographie scheint demnach nicht geeignet zu sein, die Ergebnisse im Rahmen der Stufendiagnostik zu objektivieren, da die berichtete Schmerzlinderung der Patienten nicht mit relevanten Änderungen der Körperhaltung korreliert. Der kurzfristige Effekt der gezielten Infiltration reicht möglicherweise nicht aus, um über Jahre hinweg entwickelte Fehlhaltungen zu ändern.

Key words

rasterstereography - infiltration - spine - posture - lumbar back pain

Schlüsselwörter

Rasterstereografie - Infiltrationsdiagnostik - Rückenschmerzen - Wirbelsäule - Haltung

Publication History

Article published online:
20 May 2020

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