INTERSEGMENTAL KINEMATICS IN PATIENTS WITH PERSISTENT BACK PAIN: A REVIEW OF QUANTITATIVE FLUOROSCOPY REFERRALS

Purpose and Background: Despite the rise of back pain disability, objective mechanical assessment is generally lacking. Quantification of intervertebral kinematics using fluoroscopy provides objective measurement, but its use in clinical practice has not been assessed. This study reviewed cases referred to one UK site for lumbar spine quantitative fluoroscopic (QF) examinations and compared the reasons for referral with the findings reported. Methods and Results: Fifty-seven consecutive referrals were reviewed. Patients underwent passive recumbent and/or weight-bearing active examinations in either the sagittal or both the sagittal and coronal planes. Data were extracted from anonymised QF reports and analysed for patient characteristics, reason for referral, working diagnosis at referral, level(s) of interest, previous surgical procedures and findings reported. Reports were also thematically analysed for key findings. Most patients had chronic back conditions of moderate or severe intensity. Most (38/57) were male, mean age 47 (SD 13.1) and mean complaint duration 5.4 years (0.3–32 years). They were referred mainly to investigate segmental instability (19/54) or spondylolisthesis (13/54) to inform either surgical referral or conservative management. Instability was reported in only 8/57 cases, but restricted and hypermobile levels in the same patient was also common (13/57). In 11 cases no mechanical abnormality was found. Conclusion: QF studies were requested mainly to investigate instability and inform surgical referral, but segmental instability was more frequently suspected than found. Disproportionate motion sharing was not unusual. Longitudinal studies are needed to assess the effects of this investigation on care allocation, clinical decisions, patient outcomes and health care costs.