Lumbar spine coronal balance parameters as a predictor of rehabilitation management outcomes in patients with radiculopathy due to lumbar disc herniation: A multicenter prospective case series study

Abstract

This prospective consecutive case series was conducted in 5 physiotherapy clinics in the UAE from January 2021–March 2023 to assess coronal lumbar spine radiographic parameters as a predictor of conservative therapy outcomes in patients suffering from low back and leg pain due to lumbar herniated nucleus pulposus (HNP). Ninety patients (mean age 44 yrs., 54 % male) with lumbar HNP underwent conservative therapy. All participants received lumbar spine MRI and radiography to assess spine alignment. Interventions included specific exercises, diathermy, traction, education, a home-based exercise program, and medications. Detailed demographic data was collected. Follow-up was 6-months after discharge. A successful outcome was based on a minimum of the following four outcomes: (1) reduction of radicular or leg pain by 17.5 points (0–100 NRS); (2) fatigue reduction by 7.5 points; (3) distress reduction by 5 points; and (4) interference reduction by 9.5 points. At 6-month follow-up, it was found that patient age, education, and radiographic lumbosacral angle measures significantly affected the odds of a successful outcome. Increasing age by 1-year significantly decreased the odds of success of improving pain (OR = 0.85, p = 0.016), fatigue (OR = 0.85, p = 0.016) and interference scores (OR = 0.89, p = 0.042) by 15 %, 15 % and 11 %, respectively. Lower education significantly increased the odds of success for improving pain, fatigue, and interference by 26.18, 26.18, and 7.5 (p = 0.006, = 0.006, and = 0.029, respectively). Increasing (worsening) the radiographic lumbosacral angle by each degree significantly reduced the odds of success for improving pain, fatigue, distress, and interference by 3.52, 3.52, 27.99 and 2.55, respectively (p < 0.001, <0.001, = 0.003, = 0.001). Our findings indicate that younger age, less education, and better coronal radiological lumbar spine alignment all had a substantial impact on the likelihood of success on 6-month outcomes in patients suffering from chronic lower back pain and radiculopathy due to HNP.

Keywords

• Low back pain
• Lumbar radiculopathy
• Disc herniation
• Spine radiography
• Coronal balance
• Case series