Low Back Pain in Persons with Lower Extremity Amputation: A Systematic Review of the Literature

Publication date: Available online 24 August 2018

Source: The Spine Journal

Author(s): M. Jason Highsmith, Lisa M. Goff, Amanda L. Lewandowski, Shawn Farrokhi, Brad D. Hendershot, Owen T. Hill, Christopher A. Rábago, Elizabeth Russell-Esposito, John J. Orriola, John M. Mayer

ABSTRACT

Background Context

Lower extremity amputation (LEA) is associated with elevated risk for development and progression of secondary health conditions. Low back pain (LBP) is one such condition adversely affecting function, independence, and quality of life.

Purpose

This study's purpose was to systematically review the literature to determine the strength of evidence relating the presence and severity of LBP secondary to LEA, thereby supporting the formulation of empirical evidence statements (EESs) to guide practice and future research.

Study Design/Setting

Systematic review of the literature.

Methods

A systematic review of five databases was conducted followed by evaluation of evidence and synthesis of EESs. This study was funded, in part, through an unrestricted gift by the Lincoln College Education and Research Fund to the University of South Florida Foundation.

Results

Seventeen manuscripts were included. From these, eight EESs were synthesized within the following categories: epidemiology, amputation level, function, disability, leg length, posture, spinal kinematics, osseointegrated prostheses. Only the EES on epidemiology was supported by evidence at the moderate confidence level given support by eight moderate quality studies. The four EESs for amputation level, leg length, posture and spinal kinematics were supported by evidence at the low confidence level given that each of these statements had some evidence not supporting the statement but ultimately more evidence (and of higher quality) currently supporting the statement. The remaining three EESs that addressed function, disability and osseointegrated prosthetic use were all supported by single studies or had comparable evidence that disagreed with study findings rendering insufficient evidence to support the respective EES.

Conclusions

Based on the state of the current evidence, appropriate preventative and particularly, treatment strategies to manage LBP in persons with LEA remains a knowledge gap and area of need for future study.

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