PM&R
Volume 1, Issue 6 , Pages 541-546, June 2009

Changes in Posterior Lumbar Disk Contour Abnormality with Flexion-Extension Movement in Subjects with Low Back Pain and Degenerative Disk Disease

  • Shi-Uk Lee, MD

      Affiliations

    • Seoul National University, College of Medicine, Boramae Medical Center, Department of Physical Medicine and Rehabilitation, Seoul, Korea†
    • ,
  • Jong-In Lee, MD, PhD

      Affiliations

    • Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea‡
    • ,
  • Kim Butts, PhD

      Affiliations

    • Department of Radiology, Stanford University School of Medicine, Stanford, CA§
    • ,
  • Eugene Carragee, MD

      Affiliations

    • Spine Center, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA
    • ,
  • Michael Fredericson, MD

      Affiliations

    • Division of Physical Medicine & Rehabilitation, Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway St, Redwood City, CA 94063∥
    • Corresponding Author InformationAddress correspondence to: M.F.

Received 12 September 2008; accepted 29 March 2009.

Objective

To determine whether posterior lumbar disk contour dimensions differ in the flexed seated, upright seated, and extended seated positions.

Design

Two subgroups of subjects with degenerative disk disease were compared: those with central posterior disk bulge (at L4-5 or L5-S1 levels) and those with a dark nucleus pulposus without posterior disk bulge (L3-4, L4-5, and/or L5-S1 levels).

Setting

Academic medical center.

Participants

Eight subjects with a central disk bulge and 9 subjects with a dark nucleus pulposus on magnetic resonance imaging.

Interventions

Not applicable.

Main Outcome Measures

Quantitative comparisons of posterior disk contour between neutral, flexed, and extended sitting positions.

Results

Of 8 subjects with central disk bulge, spinal flexion (from the neutral position) produced a decreased disk contour in all subjects, whereas spinal extension (from the neutral position) produced an increased disk contour in 6 subjects, a decreased disk contour in 1 subject, and no measurable change in 1 subject. Changes in posterior disk contour in subjects with a dark nucleus pulposus were variable. Approximately half increased and half decreased, but no relation to position was determined.

Conclusions

The results of this pilot study suggest a consistent pattern of decreased posterior disk contour with spinal flexion and increased posterior disk contour with spinal extension in subjects with central disk bulge, but not in those with a dark nucleus pulposus.

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  • † Disclosure: nothing to disclose
  • ‡ Disclosure: nothing to disclose
  • § Disclosure: nothing to disclose
  •  Disclosure: 1A, Intrinsic, Cytonics, Simpirica; 2B, Medtronic, Synthes, U.S. Army, Intrinsic, BioAssets; 3A, Wellpoint; 5B; 7B, Depuy; 8B, Neck Pain Task Force
  • ∥ Disclosure: 2A, Cool Systems

 Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org

PII: S1934-1482(09)00381-5

doi:10.1016/j.pmrj.2009.03.014

PM&R
Volume 1, Issue 6 , Pages 541-546, June 2009

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