Abstract
The results of lumbar fusion in chronic low back pain (LBP) patients vary considerably, and there is a need for proper patient selection. Lumbosacral orthoses have been widely used to predict outcome, however, with little scientific support. The aim of the present study was to determine the value of a pantaloon cast test in selecting chronic LBP patients for lumbar fusion or conservative management. First, a systematic review of the literature was carried out in which two independent reviewers identified studies in Medline, Cochrane and Current Contents databases. Three papers met the selection criteria. In the only study with a control group, a significantly better outcome after fusion compared to conservative treatment was found in patients who reported significant pain relief while in a cast (i.e. a positive cast test). The results of lumbar fusion, however, were not significantly different for patients with a positive and those with a negative cast test. In addition to the review, a clinical cohort study of 257 LBP patients, who had been allocated to either lumbar fusion or conservative management by a temporary external transpedicular fixation trial, was performed. Prior to allocation, all had undergone a pantaloon cast test. Patients with no history of prior spine surgery and with a positive pantaloon cast test had a better outcome after lumbar fusion than those treated conservatively (P = 0.002, χ 2 test). In patients with previous spine operations the outcomes were poor and the test was of no value. From the literature and the present patient cohort, it was concluded that only in chronic LBP patients without prior spine surgery, a pantaloon cast test with substantial pain relief suggests a favorable outcome of lumbar fusion compared to conservative management. The test has no value in patients who have had previous spine surgery.
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Ahlgren SA, Hansen T (1978) The use of lumbosacral corsets prescribed for low back pain. Prosthet Orthot Int 2(2):101–104
Alaranta H, Hurri H (1988) Compliance and subjective relief by corset treatment in chronic low back pain. Scand J Rehabil Med 20(3):133–136
Axelsson P, Johnsson R, Stromqvist B (1992) Effect of lumbar orthosis on intervertebral mobility. A roentgen stereophotogrammetric analysis. Spine 17(6):678–681
Axelsson P, Johnsson R, Stromqvist B (1993) Lumbar orthosis with unilateral hip immobilization. Effect on intervertebral mobility determined by roentgen stereophotogrammetric analysis. Spine 18(7):876–879
Axelsson P, Johnsson R, Stromqvist B, Nilsson LT, Akesson M (1995) Orthosis as prognostic instrument in lumbar fusion: no predictive value in 50 cases followed prospectively. J Spinal Disord 8(4):284–288
Buchalter D, Kahanovitz N, Viola K, Dorsky S, Nordin M (1988) Three-dimensional spinal motion measurements. Part 2: A noninvasive assessment of lumbar brace immobilization of the spine. J Spinal Disord 1(4):284–286
Calmels P, Fayolle-Minon I (1996) An update on orthotic devices for the lumbar spine based on a review of the literature. Rev Rhum Engl Ed 63(4):285–291
Cholewicki J, Juluru K, Radebold A, Panjabi MM, McGill SM (1999) Lumbar spine stability can be augmented with an abdominal belt and/or increased intra-abdominal pressure. Eur Spine J 8(5):388–395
Cholewicki J, Alvi K, Silfies SP, Bartolomei J (2003) Comparison of motion restriction and trunk stiffness provided by three thoracolumbosacral orthoses (TLSOs). J Spinal Disord Tech 16(5):461–468
Deyo RA, Cherkin D, Conrad D, Volinn E (1991) Cost, controversy, crisis: low back pain and the health of the public. Annu Rev Public Health 12:141–156
Dunsker SB (1990) Lumbar spine stabilization: indications. Clin Neurosurg 36:147–158
Esses SI, Moro JK (1993) The value of facet joint blocks in patient selection for lumbar fusion. Spine 18(2):185–190
Esses SI, Botsford DJ, Kostuik JP (1989) The role of external spinal skeletal fixation in the assessment of low-back disorders. Spine 14(6):594–601
Fritzell P, Hagg O, Wessberg P, Nordwall A (2001) 2001 Volvo award winner in clinical studies: lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine 26(23):2521–2532
Gibson JN, Grant IC, Waddell G (1999) The Cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis. Spine 24(17):1820–1832
Jackson RK, Boston DA, Edge AJ (1985) Lateral mass fusion. A prospective study of a consecutive series with long-term follow-up. Spine 10(9):828–832
Jeanneret B, Jovanovic M, Magerl F (1994) Percutaneous diagnostic stabilization for low back pain. Correlation with results after fusion operations. Clin Orthop 304:130–138
Krismer M (2002) Fusion of the lumbar spine. A consideration of the indications. J Bone Joint Surg Br 84(6):783–794
Lantz SA, Schultz AB (1986) Lumbar spine orthosis wearing. I. Restriction of gross body motions. Spine 11(8):834–837
Lehmann TR, Spratt KF, Tozzi JE et al (1987) Long-term follow-up of lower lumbar fusion patients. Spine 12(2):97–104
Lund T, Oxland TR, Nydegger T, Schlenzka D, Laine T, Heini P (2002) Is there a connection between the clinical response after an external fixation test or a subsequent lumbar fusion and the pre-test intervertebral kinematics? Spine 27(23):2726–2733
Markwalder TM, Reulen HJ (1989) Diagnostic approach in instability and irritative state of a “lumbar motion segment” following disc surgery–failed back surgery syndrome. Acta Neurochir (Wien) 99(1–2):51–57
McGill S, Seguin J, Bennett G (1994) Passive stiffness of the lumbar torso in flexion, extension, lateral bending, and axial rotation. Effect of belt wearing and breath holding. Spine 19(6):696–704
Nachemson AL (1985) Fusion for low back pain and sciatica. Acta Orthop Scand 56(4):285–286
Nachemson A, Morris JM (1964) In vivo measurements of intradiscal pressure. Discometry, a method for the determination of pressure in the lower lumbar discs. J Bone Joint Surg Am 46:1077–1092
O’Beirne J, O’Neill D, Gallagher J, Williams DH (1992) Spinal fusion for back pain: a clinical and radiological review. J Spinal Disord 5(1):32–38
Olerud S, Karlstrom G, Sjostrom L (1988) Transpedicular fixation of thoracolumbar vertebral fractures. Clin Orthop 227:44–51
Price DD, McGrath PA, Rafii A, Buckingham B (1983) The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 17(1):45–56
Rask B, Dall BE (1993) Use of the pantaloon cast for the selection of fusion candidates in the treatment of chronic low back pain. Clin Orthop 288:148–157
van der Schaaf DB, van Limbeek J, Pavlov PW (1999) Temporary external transpedicular fixation of the lumbosacral spine. Spine 24(5):481–484
Soini JR, Seitsalo SK (1993) The external fixation test of the lumbar spine. 30 complications in 25 of 100 consecutive patients. Acta Orthop Scand 64(2):147–149
Tokuhashi Y, Matsuzaki H, Sano S (1993) Evaluation of clinical lumbar instability using the treadmill. Spine 18(15):2321–2324
Tuong NH, Dansereau J, Maurais G, Herrera R (1998) Three-dimensional evaluation of lumbar orthosis effects on spinal behavior. J Rehabil Res Dev 35(1):34–42
Turner JA, Ersek M, Herron L et al (1992) Patient outcomes after lumbar spinal fusions. JAMA 268(7):907–911
Turner JA, Deyo RA, Loeser JD, Von Korff M, Fordyce WE (1994) The importance of placebo effects in pain treatment and research. JAMA 271(20):1609–1614
Wetzel FT, LaRocca SH, Lowery GL, Aprill CN (1994) The treatment of lumbar spinal pain syndromes diagnosed by discography. Lumbar arthrodesis. Spine 19(7):792–800
Willems PC, Nienhuis B, Sietsma M, van der Schaaf DB, Pavlov PW (1997) The effect of a plaster cast on lumbosacral joint motion. An in vivo assessment with precision motion analysis system. Spine 22(11):1229–1234
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Willems, P.C., Elmans, L., Anderson, P.G. et al. The value of a pantaloon cast test in surgical decision making for chronic low back pain patients: a systematic review of the literature supplemented with a prospective cohort study . Eur Spine J 15, 1487–1494 (2006). https://doi.org/10.1007/s00586-006-0121-0
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DOI: https://doi.org/10.1007/s00586-006-0121-0