Spinal Structural Canal Measurements And Their Relationships To Pain, Disability, And Physical Function Among Older Adults With And Without Chronic Low Back Pain
Date
2016-05
Authors
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Publisher
University of Delaware
Abstract
In the United States, approximately 6 million older adults experience frequent low
back pain (LBP) and 23% report suffering from LBP of moderate intensity. Among
older adults, chronic LBP is associated with impaired physical function and is one of
the most disabling chronic conditions. LBP may be accompanied by radicular
symptoms, i.e. pain, numbness, tingling, and/or weakness, that radiates into the lower
extremities. Clinical symptoms and spinal canal structural measurements (i.e.
anteroposterior canal diameter (APCD), canal cross-sectional area (CCSA), and dural
sac cross-sectional area (DSCSA)) have been used to diagnosis adults with chronic
LBP, with and without leg pain, and to justify surgical interventions. Self-report
measures assess a patient’s personal perception of function, while performance-based
measures objectively assess a person’s ability to perform an activity. Thus, both types
of measures are important in assessing a patient’s physical function and LBP-related
disability. Among older adults with and without leg pain, there may be a relationship
between the size of spinal canal structures, i.e. the spinal canal and the dural sac, and
pain intensity, physical function, and disability. Relationships in the presence of LBP
may differ from those found among older adults without LBP, while relationships
found among older adults with chronic LBP + leg pain may differ from relationships
found among older adults with chronic LBP only. Also located in the spinal canal is epidural fat, which has been proposed to be protective due to its anatomical location.
What remains unknown is how this epidural fat is related to pain, physical function,
and disability among older adults with chronic LBP with and without leg pain.
Similarly, it is possible that relationships found among epidural fat and pain, function,
and disability, among older adults with chronic LBP may differ from older adults
without LBP. The specific aims of this thesis are: (1) to establish inter-examiner
measurement reliability for structural spinal canal measurements among older adults
with chronic LBP, (2) to assess for differences in structural spinal canal measurements
among older adults with chronic LBP, chronic LBP + leg pain, and without LBP, (3)
to examine relationships among structural spinal canal measurements and pain,
physical function, i.e. self-report and performance-based, and disability, among older
adults with LBP, LBP + leg pain, and without LBP, and (4) to examine epidural fat
and its relationships to pain, physical function, and disability, among older adults with
chronic LBP, chronic LBP + leg pain, and without LBP. Findings indicate that spinal
canal structural measurement can be reliably determined. Measurements proposed in
previous studies, i.e. APCD, CCSA, and DSCSA were not significantly different
among older adults with and without chronic LBP and were not different between
older adults with LBP as compared to those without LBP. Ratio spinal canal
measurements emerged as a means of distinguishing between older adults with chronic LBP (with or without leg pain) and without LBP. Further, ratio measurements were associated with pain, physical function, and disability (beyond covariates) among
older adults with chronic LBP but not among those without LBP. Epidural fat helps to explain LBP intensity, self-reported and performance-based physical function among
older adults with chronic LBP without leg pain; greater epidural fat in those with
lower LBP intensities and better physical function, supporting the theory that epidural
fat may be protective. Future work is needed to evaluate these relationships
longitudinally.
Description
Keywords
low back pain, exercise science, spinal structural canal, older adults