Disorders of postural balance and spinal biomechanics in patients with operated spine syndrome

Objective. To study the peculiarities of postural balance disorders and spine biomechanics, as well as their correlation with the severity of pain syndrome in patients with operated spine syndrome (OSS). Material and methods. The study involved 86 patients aged from 27 to 65 years, who were divided into 3 groups: 1st (main; n=35) – patients with OSS who underwent microdiscectomy at the lumbar level, after which the pain syndrome persisted; 2nd (n=35) – patients with radiculopathy without surgical intervention in the anamnesis; 3rd (n=16) – patients without OSS who underwent microdiscectomy at the lumbar spine. The groups were comparable in age and gender. The study groups were analyzed for the clinical characteristics of pain syndrome, the myotatic reflex of muscles under load using manual muscle testing, as well as postural balance. Results. In group 1, there was a dependence of the intensity of pain syndrome on the presence of myofascial pain trigger zones in the piriformis muscles contralateral to the affected leg and in the quadratus lumborum muscle ipsilaterally. In addition, pain intensity in in group 1 was strongly correlated with decreased bilateral rectus femoris strength. In group 1 a stabilometric study revealed a dependence of the pain syndrome on the presence of frontal asymmetry. In group 2, during manual muscle testing and stabilometric studies, a correlation was observed between a decrease in calf strength on the affected leg and the presence of myofascial pain syndrome in the piriformis muscle ipsilateral to the affected leg. In group 3, biomechanical disorders were revealed in the form of moderate frontal and sagittal asymmetry, as well as hypotonia of the rectus abdominis muscle, iliopsoas muscles, rectus femoris muscles, calf flexor muscles, and calf muscles. However, the severity of these data differs significantly from those in groups 1 and 2. Conclusion. The formation and maintenance of pain in patients with OSS is influenced not only by degenerative-dystrophic changes at the level of the affected intervertebral disc with compression of the spinal roots and arthrosis of the facet joints, but also by disturbances in postural balance and biomechanics of the spine. An imbalance of muscle tone in the postural muscles is the cause of the development of postural myoadaptive overload syndromes in the muscles of the lower back and legs. Therefore, it is very important to include manual muscle testing in the examination of patients with back pain to determine the causes of biomechanical muscle overload. Treatment and rehabilitation should include, in addition to drug treatment, sets of individual exercises aimed at restoring muscle tone and strength and post-isometric relaxation to inactivate trigger points.