Understanding low back pain in traumatic lower extremity amputees: a systematic review.

Traumatic injuries can lead to lower limb amputations at different levels (transfemoral, transtibial, knee disarticulation and transpelvic) and, compared to the general population, a high percentage of these patients suffer from chronic low back pain: 31%-37 % vs. 47.7% -76.6%. In fact, there is evidence that low back pain is more bothersome than any other type of pain in the amputee population.Low back pain is considered a multidimensional and multifactorial condition; Physical, biomechanical, physiological and personal factors contribute to its incidence. The aim of this study is to review the literature on the prevalence, mechanical etiologies, and consequences of low back pain for traumatic lower extremity amputees.

Eligibility Criteria

In addition to transpelvic, all types of lower limb amputees were included in the study: unilateral, bilateral, transfemoral, traumatic transtibial, and knee disarticulation amputees. All included studies contain low back pain assessment, biomechanical assessment of daily tasks, objective marker or imaging studies.
Study selection
A total of 1810 articles were found during the search and 11 full-text articles were selected for inclusion and review.
Mechanical or Anatomical Etiologies.
1. Motion AnalysisNone of the studies revealed any relevant findings regarding potential mechanisms of low-back pain, but the quality of the evidence is poor.
2. ModelingAnterior-posterior shear and velocity-related compressions were higher in the amputee group (~81% and 31%) compared to the non-disabled group (~44% and ~22%). To stabilize their center of mass, amputees increase stiffness in some planes of motion, and their continued efforts to maintain balance result in postural asymmetry and low back pain. In addition, in the amputee population, we not only found an energy production at the L5/S1 level three times higher during walking, but also during standing-sitting and sitting-standing postural changes. Even with a small population size, the results are intended to recognize potential causes of chronic low back pain.
3. ScanStudies found psoas hypertrophy of the intact limb in patients with unilateral transfemoral amputations.
Consequences of chronic pain and its effect on daily life.
Low back pain greatly contributed to poor quality of life as it interfered with daily activities. It was referred in 28%-39% of the questionnaires and 38.7% of the respondents did not have any pain-free month in the last 3 years.
The incidence of low back pain in the traumatic lower extremity amputee population (52-64%) was similar to that in the mixed amputee population (47.7%-76.6%).Reports have linked the use of prostheses to the prevalence of low back pain, and because patients are typically younger, more active, and wear their prostheses longer, they are at higher risk of low back pain at any given time, even if they don't. Haven't experienced any discomfort yet.Psoas hypertrophy on the intact side of unilateral amputees also plays an important role in the development of low back pain, as it can result in loss of hip extension and thus has implications for posture and spinal loading.Military and political amputees are typically fitter, stronger, and wear better prosthetics than the general population; for this reason, they are an interesting group to analyze and compare. However, no clear distinction has been made in the group of traumatic amputees to separate these patients and further research will need to be designed for further data collection.Since low back pain is present in such a high percentage of amputees, there is a need to better understand its causes and influencing factors so that pain can be managed and prevented. Our understanding of this multidimensional condition is limited and further study is required.
American congress of rehabilitation medicine