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Iatrogenic leg length inequality may cause low back pain due to scoliosis

Year 2022, Volume: 39 Issue: 2, 516 - 520, 18.03.2022

Abstract

The aim of this manuscript is to discuss iatrogenic leg length inequality as an etiologic factor of degenerative scoliosis and low back pain.
Iatrogenic type leg length inequality prevalence is getting higher recently, because of increasing number of hip and knee surgery parallel to the increasing number of elder people in population. We presented four cases, who had low back pain due to degenerative scoliosis caused by leg length inequality. Case 1, 2 and 3 were elder people who had previous knee or hip surgery. Case 4 was a young lady who had low back pain due to degenerative scoliosis and leg length inequality and she had no previous surgery.
In Case 1, 2 and 3, leg length inequality was iatrogenic type which was caused by hip or knee surgery. This iatrogenic leg length inequality caused degenerative scoliosis same as in case 4, who had anatomical leg length inequality.
Iatrogenic leg length inequality may cause degenerative scoliosis, thus low back pain. Scoliosis caused by leg length inequality cannot be compensated by elder people or even young people whose abdominal muscles week.

References

  • Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15 Suppl 2:S192-300.
  • Dagenais S, Caro J,Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008;8(1):8-20.
  • Friedly J, Standaert C,Chan L. Epidemiology of spine care: the back pain dilemma. Phys Med Rehabil Clin N Am. 2010;21(4):659-77.
  • Juniper M, Le TK,Mladsi D. The epidemiology, economic burden, and pharmacological treatment of chronic low back pain in France, Germany, Italy, Spain and the UK: a literature-based review. Expert Opin Pharmacother. 2009;10(16):2581-92.
  • Kim TE, Lee RG, Park SY,Oh IH. Measuring Trends in the Socioeconomic Burden of Disease in Korea, 2007-2015. J Prev Med Public Health. 2022;55(1):19-27.
  • Friberg O. Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality. Spine (Phila Pa 1976). 1983;8(6):643-51.
  • Giles LG,Taylor JR. Low-back pain associated with leg length inequality. Spine (Phila Pa 1976). 1981;6(5):510-21.
  • Clark CR, Huddleston HD, Schoch EP, 3rd,Thomas BJ. Leg-length discrepancy after total hip arthroplasty. J Am Acad Orthop Surg. 2006;14(1):38-45.
  • Okuzu Y, Miyahara T, Goto K, Kuroda Y, Kawai T,Matsuda S. Investigating sagittal spinal alignment, low back pain, and clinical outcomes after total hip arthroplasty for lumbar hyperlordosis: a retrospective study. Arch Orthop Trauma Surg. 2021.
  • Youdas JW, Garrett TR, Egan KS,Therneau TM. Lumbar lordosis and pelvic inclination in adults with chronic low back pain. Phys Ther. 2000;80(3):261-75.
  • Offierski CM,MacNab I. Hip-spine syndrome. Spine (Phila Pa 1976). 1983;8(3):316-21.
  • Murata Y, Takahashi K, Yamagata M, Hanaoka E,Moriya H. The knee-spine syndrome. Association between lumbar lordosis and extension of the knee. J Bone Joint Surg Br. 2003;85(1):95-9.
  • Cooperstein R. The relationship between pelvic torsion and anatomical leg length inequality: a review of the literature. J Chiropr Med. 2010;9(2):96-7.
  • McCaw ST,Bates BT. Biomechanical implications of mild leg length inequality. Br J Sports Med. 1991;25(1):10-3.
  • Subotnick SI. Limb length discrepancies of the lower extremity (the short leg syndrome). J Orthop Sports Phys Ther. 1981;3(1):11-6.
  • Gross RH. Leg length discrepancy in marathon runners. Am J Sports Med. 1983;11(3):121-4.
  • Botte RR. An interpretation of the pronation syndrome and foot types of patients with low back pain. J Am Podiatry Assoc. 1981;71(5):243-53.
  • Grundy PF,Roberts CJ. Does unequal leg length cause back pain? A case-control study. Lancet. 1984;2(8397):256-8.
  • Silva FE,Lenke LG. Adult degenerative scoliosis: evaluation and management. Neurosurg Focus. 2010;28(3):E1.
  • Giles LG,Taylor JR. Lumbar spine structural changes associated with leg length inequality. Spine (Phila Pa 1976). 1982;7(2):159-62.
  • Latz D, Frenken M, Schiffner E, Knautz M, Quante WA, Windolf J, et al. Assessment of glycosaminoglycan content in intervertebral discs of patients with leg length discrepancy: A pilot study. J Orthop. 2019;16(5):363-7.
  • Balik MS, Kanat A, Erkut A, Ozdemir B,Batcik OE. Inequality in leg length is important for the understanding of the pathophysiology of lumbar disc herniation. J Craniovertebr Junction Spine. 2016;7(2):87-90.
  • Nourbakhsh MR,Arab AM. Relationship between mechanical factors and incidence of low back pain. J Orthop Sports Phys Ther. 2002;32(9):447-60.
  • St-Onge MP,Gallagher D. Body composition changes with aging: the cause or the result of alterations in metabolic rate and macronutrient oxidation? Nutrition. 2010;26(2):152-5.
  • Bhave A, Mont M, Tennis S, Nickey M, Starr R,Etienne G. Functional problems and treatment solutions after total hip and knee joint arthroplasty. J Bone Joint Surg Am. 2005;87 Suppl 2:9-21.
  • Edeen J, Sharkey PF,Alexander AH. Clinical significance of leg-length inequality after total hip arthroplasty. Am J Orthop (Belle Mead NJ). 1995;24(4):347-51.
  • Goldstein WM, Gordon A,Branson JJ. Leg length inequality in total hip arthroplasty. Orthopedics. 2005;28(9 Suppl):s1037-40.
  • Konyves A,Bannister GC. The importance of leg length discrepancy after total hip arthroplasty. J Bone Joint Surg Br. 2005;87(2):155-7.
  • Ulrich SD, Bhave A, Marker DR, Seyler TM,Mont MA. Focused rehabilitation treatment of poorly functioning total knee arthroplasties. Clin Orthop Relat Res. 2007;464:138-45.
  • Vaidya SV, Patel MR, Panghate AN,Rathod PA. Total knee arthroplasty: Limb length discrepancy and functional outcome. Indian J Orthop. 2010;44(3):300-7.
  • Friberg O. Biomechanical significance of the correct length of lower limb prostheses: a clinical and radiological study. Prosthet Orthot Int. 1984;8(3):124-9.
  • Gofton JP,Trueman GE. Studies in osteoarthritis of the hip. II. Osteoarthritis of the hip and leg-length disparity. Can Med Assoc J. 1971;104(9):791-9.
  • Sharpe CR. Leg length inequality. Can Fam Physician. 1983;29:332-6.
  • Golightly YM, Tate JJ, Burns CB,Gross MT. Changes in pain and disability secondary to shoe lift intervention in subjects with limb length inequality and chronic low back pain: a preliminary report. J Orthop Sports Phys Ther. 2007;37(7):380-8.
  • Havran M, Scholten JD, Breuer P, Lundberg J, Kochersberger G, Newman D, et al. Deconstructing Chronic Low Back Pain in the Older Adult-Step-by-Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part XII: Leg Length Discrepancy. Pain Med. 2016;17(12):2230-7.
Year 2022, Volume: 39 Issue: 2, 516 - 520, 18.03.2022

Abstract

References

  • Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15 Suppl 2:S192-300.
  • Dagenais S, Caro J,Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008;8(1):8-20.
  • Friedly J, Standaert C,Chan L. Epidemiology of spine care: the back pain dilemma. Phys Med Rehabil Clin N Am. 2010;21(4):659-77.
  • Juniper M, Le TK,Mladsi D. The epidemiology, economic burden, and pharmacological treatment of chronic low back pain in France, Germany, Italy, Spain and the UK: a literature-based review. Expert Opin Pharmacother. 2009;10(16):2581-92.
  • Kim TE, Lee RG, Park SY,Oh IH. Measuring Trends in the Socioeconomic Burden of Disease in Korea, 2007-2015. J Prev Med Public Health. 2022;55(1):19-27.
  • Friberg O. Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality. Spine (Phila Pa 1976). 1983;8(6):643-51.
  • Giles LG,Taylor JR. Low-back pain associated with leg length inequality. Spine (Phila Pa 1976). 1981;6(5):510-21.
  • Clark CR, Huddleston HD, Schoch EP, 3rd,Thomas BJ. Leg-length discrepancy after total hip arthroplasty. J Am Acad Orthop Surg. 2006;14(1):38-45.
  • Okuzu Y, Miyahara T, Goto K, Kuroda Y, Kawai T,Matsuda S. Investigating sagittal spinal alignment, low back pain, and clinical outcomes after total hip arthroplasty for lumbar hyperlordosis: a retrospective study. Arch Orthop Trauma Surg. 2021.
  • Youdas JW, Garrett TR, Egan KS,Therneau TM. Lumbar lordosis and pelvic inclination in adults with chronic low back pain. Phys Ther. 2000;80(3):261-75.
  • Offierski CM,MacNab I. Hip-spine syndrome. Spine (Phila Pa 1976). 1983;8(3):316-21.
  • Murata Y, Takahashi K, Yamagata M, Hanaoka E,Moriya H. The knee-spine syndrome. Association between lumbar lordosis and extension of the knee. J Bone Joint Surg Br. 2003;85(1):95-9.
  • Cooperstein R. The relationship between pelvic torsion and anatomical leg length inequality: a review of the literature. J Chiropr Med. 2010;9(2):96-7.
  • McCaw ST,Bates BT. Biomechanical implications of mild leg length inequality. Br J Sports Med. 1991;25(1):10-3.
  • Subotnick SI. Limb length discrepancies of the lower extremity (the short leg syndrome). J Orthop Sports Phys Ther. 1981;3(1):11-6.
  • Gross RH. Leg length discrepancy in marathon runners. Am J Sports Med. 1983;11(3):121-4.
  • Botte RR. An interpretation of the pronation syndrome and foot types of patients with low back pain. J Am Podiatry Assoc. 1981;71(5):243-53.
  • Grundy PF,Roberts CJ. Does unequal leg length cause back pain? A case-control study. Lancet. 1984;2(8397):256-8.
  • Silva FE,Lenke LG. Adult degenerative scoliosis: evaluation and management. Neurosurg Focus. 2010;28(3):E1.
  • Giles LG,Taylor JR. Lumbar spine structural changes associated with leg length inequality. Spine (Phila Pa 1976). 1982;7(2):159-62.
  • Latz D, Frenken M, Schiffner E, Knautz M, Quante WA, Windolf J, et al. Assessment of glycosaminoglycan content in intervertebral discs of patients with leg length discrepancy: A pilot study. J Orthop. 2019;16(5):363-7.
  • Balik MS, Kanat A, Erkut A, Ozdemir B,Batcik OE. Inequality in leg length is important for the understanding of the pathophysiology of lumbar disc herniation. J Craniovertebr Junction Spine. 2016;7(2):87-90.
  • Nourbakhsh MR,Arab AM. Relationship between mechanical factors and incidence of low back pain. J Orthop Sports Phys Ther. 2002;32(9):447-60.
  • St-Onge MP,Gallagher D. Body composition changes with aging: the cause or the result of alterations in metabolic rate and macronutrient oxidation? Nutrition. 2010;26(2):152-5.
  • Bhave A, Mont M, Tennis S, Nickey M, Starr R,Etienne G. Functional problems and treatment solutions after total hip and knee joint arthroplasty. J Bone Joint Surg Am. 2005;87 Suppl 2:9-21.
  • Edeen J, Sharkey PF,Alexander AH. Clinical significance of leg-length inequality after total hip arthroplasty. Am J Orthop (Belle Mead NJ). 1995;24(4):347-51.
  • Goldstein WM, Gordon A,Branson JJ. Leg length inequality in total hip arthroplasty. Orthopedics. 2005;28(9 Suppl):s1037-40.
  • Konyves A,Bannister GC. The importance of leg length discrepancy after total hip arthroplasty. J Bone Joint Surg Br. 2005;87(2):155-7.
  • Ulrich SD, Bhave A, Marker DR, Seyler TM,Mont MA. Focused rehabilitation treatment of poorly functioning total knee arthroplasties. Clin Orthop Relat Res. 2007;464:138-45.
  • Vaidya SV, Patel MR, Panghate AN,Rathod PA. Total knee arthroplasty: Limb length discrepancy and functional outcome. Indian J Orthop. 2010;44(3):300-7.
  • Friberg O. Biomechanical significance of the correct length of lower limb prostheses: a clinical and radiological study. Prosthet Orthot Int. 1984;8(3):124-9.
  • Gofton JP,Trueman GE. Studies in osteoarthritis of the hip. II. Osteoarthritis of the hip and leg-length disparity. Can Med Assoc J. 1971;104(9):791-9.
  • Sharpe CR. Leg length inequality. Can Fam Physician. 1983;29:332-6.
  • Golightly YM, Tate JJ, Burns CB,Gross MT. Changes in pain and disability secondary to shoe lift intervention in subjects with limb length inequality and chronic low back pain: a preliminary report. J Orthop Sports Phys Ther. 2007;37(7):380-8.
  • Havran M, Scholten JD, Breuer P, Lundberg J, Kochersberger G, Newman D, et al. Deconstructing Chronic Low Back Pain in the Older Adult-Step-by-Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part XII: Leg Length Discrepancy. Pain Med. 2016;17(12):2230-7.
There are 35 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Clinical Research
Authors

Aykan Ulus 0000-0001-8373-7072

Ahmet Hilmi  Kaya 0000-0002-2160-6939

Alparslan Şenel 0000-0003-3530-5480

Early Pub Date March 18, 2022
Publication Date March 18, 2022
Submission Date March 7, 2022
Acceptance Date March 10, 2022
Published in Issue Year 2022 Volume: 39 Issue: 2

Cite

APA Ulus, A., Kaya, A. H., & Şenel, A. (2022). Iatrogenic leg length inequality may cause low back pain due to scoliosis. Journal of Experimental and Clinical Medicine, 39(2), 516-520.
AMA Ulus A, Kaya AH, Şenel A. Iatrogenic leg length inequality may cause low back pain due to scoliosis. J. Exp. Clin. Med. March 2022;39(2):516-520.
Chicago Ulus, Aykan, AhmetHilmi Kaya, and Alparslan Şenel. “Iatrogenic Leg Length Inequality May Cause Low Back Pain Due to Scoliosis”. Journal of Experimental and Clinical Medicine 39, no. 2 (March 2022): 516-20.
EndNote Ulus A, Kaya AH, Şenel A (March 1, 2022) Iatrogenic leg length inequality may cause low back pain due to scoliosis. Journal of Experimental and Clinical Medicine 39 2 516–520.
IEEE A. Ulus, A. H. Kaya, and A. Şenel, “Iatrogenic leg length inequality may cause low back pain due to scoliosis”, J. Exp. Clin. Med., vol. 39, no. 2, pp. 516–520, 2022.
ISNAD Ulus, Aykan et al. “Iatrogenic Leg Length Inequality May Cause Low Back Pain Due to Scoliosis”. Journal of Experimental and Clinical Medicine 39/2 (March 2022), 516-520.
JAMA Ulus A, Kaya AH, Şenel A. Iatrogenic leg length inequality may cause low back pain due to scoliosis. J. Exp. Clin. Med. 2022;39:516–520.
MLA Ulus, Aykan et al. “Iatrogenic Leg Length Inequality May Cause Low Back Pain Due to Scoliosis”. Journal of Experimental and Clinical Medicine, vol. 39, no. 2, 2022, pp. 516-20.
Vancouver Ulus A, Kaya AH, Şenel A. Iatrogenic leg length inequality may cause low back pain due to scoliosis. J. Exp. Clin. Med. 2022;39(2):516-20.