Journal of Osteopathic Medicine, 2004/10, 7(2):70-78. doi: 10.1016/S1443-8461(04)80015-7, type of study: ,obs,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Full text    (http://www.sciencedirect.com/science/article/pii/S1443846104800157)

Keywords:

anatomy [113]
low back pain [523]
lumbosacral spine [1]
observational study [246]
spina bifida occulta [1]

Abstract:

Background: Anecdotal osteopathic clinical experience suggested that spina bifida occulta (SBO) might adversely be complicating the presentation and prognosis of acute and chronic low back pain, yet the finding of spina bifida occulta (SBO) in anteroposterior lumbosacral radiological examinations is usually regarded as an innocent radiological finding. Review of the literature indicated that lumbosacral SBO is associated with an increased incidence of posterior intervertebral disc herniation. Aims and Objectives: The aim of this anatomical study was to examine the null hypothesis that SBO of the lumbosacral spine is not associated with variations in the expected appearance of the overlying posterior soft tissues. Materials and Methods: Thirty-six cadavers were initially available for radiological study. Eight cases of SBO were radiologically identified and dissected. Four further cadavers were selected as dissection controls on the basis of having a normal radiographic appearance of the lumbosacral spine. Comparisons were drawn between the soft tissues of the lumbosacral region of SBO cases and the controls. Discussion: SBO of the lumbosacral spine is associated with variation of the expected appearance in the overlying posterior soft tissues. A rationale is discussed that links altered anatomy, vertebral mechanics and accelerated degeneration of the related intervertebral disc. These biomechanical and clinical rationales are further offered as a reason for the classification of SBO as a reportable radiological finding. This rationale provides a theoretical explanation for the clinical differences noted in the routine osteopathic management of low back pain complicated by the presence of SBO. Conclusions: The results suggest that there are variations in the superficial soft tissues of the lumbosacral spine associated with the radiographic finding of SBO.