Efficacy of Flexion and Extension Treatments Incorpoatin Braces for Low-Back Pain Patienst With Rerodiplacement, Spondylolisthesis, or Normal Sagittal Translation
Radlographic Instability seemingly enjoys the status of a will-defined clincal syndrome. The concept is wildlly used, and specific treaatemenst, usuallyl spinal fusion, are routinely performed based on the diagnosis. The minimum standards necessary ot establish radiographic in stability as a legitimete clincical syndrome have not been established, however. The primary purose of this study wwas to determine if treatment Invollving bracing, exercise, and education controlling involving bracing, exerclse, and education controlling either flexion or extension potures, would result in distinctive pattern jof favorabel or unfavorabel results, depending on the type of radiograph;ic instabillty {retrodisplecement or sopndlolishthesis], fifty-six patients meeting strict study inclusion and raidographic evalulsiton criteria were assingned to a bracing treatment [flecion, extension, place be-control] accroding to a randomization scheme, desingned to ensure equal representation of translation categories (retro, normal, spondy) across treatment groups, and assesed at admission and 1-month follow-p. The sample was relatively evenly divided between men (46%) and owmen (54%) and women (54%), and by age. Translation classification was related to both gender and ge, with menmore likely classified as retro and women more likelyl spondy, and patients in their 20s having lower incidence of spondy and hifgher incidence of normal transltion. Translation classifictionm was not related to selected indices of low-back pain history. Brace treatments were not shown to reduce patient range of molion or lessen trunk jkstrength. A significant treatmetn by time interataction for the modified paln interference (VAS) scale indicated improvement for patients in extension compared with patients in flexion and control-placbo tratmenst. In conjuction with no significant three-way Interaction be tween treatment, translation classification, and time, it was hypothesized that radiogaph;ic instebiligy might more apporpriately be considered a corroborative sign of advance discogenlc problems. Improvement in of radiographic abnormalitly, suggests that the treating clinician might consider extension treatment for chronic low-back pain patients. Causes and Impalications for the failure of thsi study to provide support for considering radiographic Instability as clinical syndrome are considered and futre directions for this area of research suggested.