Paralumbar Spine Disease as a Cause of Low Back Pain in Older Adults

Abstract

Introduction Low back pain (LBP) is a major contributor to decreases in the ability to perform activities of daily living (ADL) in older adults. Paralumbar spine disease (PLSD) is a common cause of LBP. We aimed to investigate the causes of LBP, including PLSD, among older adults. Methods Among 744 consecutive patients with LBP, 75 patients (10.1%) aged >80 years (25 males and 50 females) were included. The average patient age was 83.9 years. All patients were evaluated using lumbar magnetic resonance imaging (MRI) and radiography to diagnose the causes of LBP. PLSD was diagnosed based on clinical symptoms, palpation, and the effects of the block. Results Eleven patients (11/75, 14.7%) had acute osteoporotic vertebral fractures. Twenty-eight of the remaining 64 patients exhibited decreased LBP with oral medication, and six (6/75, 8.0%) exhibited lumbar spinal canal stenosis on MRI. PLSD was suspected in 19 of the remaining 30 cases based on clinical symptoms and palpation. Blocks were effective in 16 patients with PLSD, which involved superior cluneal nerve entrapment (SCN-E) in eight patients (10.7%), middle cluneal nerve entrapment (MCN-E) in nine patients (12.0%), sacroiliac joint (SIJ) pain in five patients (6.7%), and gluteus medius muscle (GMeM) pain in three patients (4.0%). The average numerical rating scale (NRS) scores for pain changed from 7.5 ± 1.5 before treatment to 1.3 ± 0.9 at discharge (p < 0.05). Conclusion Osteoporotic acute vertebral fracture (14.7%) was identified as the cause of LBP in older adults. Block therapy for PLSD may aid in the diagnosis and treatment of non-specific LBP.

Keywords: low back pain; middle cluneal nerve; older adults; paralumbar spine disease; superior cluneal nerve.

Figure 1. Flow chart for diagnosing low back pain (LBP)

Figure 2. Outcome of block treatment for paralumbar spine disease in 19 patients

Outcome assessment: to evaluate the clinical outcomes of block treatment for paralumbar spine disease in 19 low back pain patients using NRS, JOA, and RDQ, we compared NRS, JOA, and RDQ scores between admission and discharge. The boxes and error bars represent the mean value and standard deviation, respectively; individual data points are also plotted. A significant difference was observed in all evaluations. The mean values with p < 0.05 are considered statistically significant NRS, numerical rating scale; JOA, Japanese Orthopedic Association; RDQ, Roland-Morris Disability Questionnaire