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The general population reports periodic low back pain with a prevalence rate of 20 to 40%. For people who have sustained a lower limb amputation the prevalence rate ranges from 50 to 87%. Patients with amputations described frequent back pain several times per week. The level of amputation is inconsistent when correlating the frequency of back pain.

 Factors involved:

  • Prosthetic height resulting in leg length discrepancy
  • Lumbar spine mechanics
  • Level of amputation
  • Back strength and endurance

Associated yellow flags:

  • Catastrophizing
  • Fear of movement and re-injury
  • Distressed and low in mood
  • Report of extreme pain disproportionate to the condition

These yellow flags need to be considered, as there is a known association between psychological factors and patient function/pain severity. The amputee demonstrates asymmetries in their gait due to compensatory strategies, which are employed in response the loss of one or more limbs. These compensatory changes may bring on the development of low back pain after years of repetitive abnormal gait. This repetitive abnormal gait pattern will result in an accelerated degeneration of the lumbar spine resulting in degenerative disc disease, spondylosis and spinal stenosis. To minimize the accelerated deterioration of the lumbar spine the patient should keep their prosthesis in good repair and work with the prosthetic specialist.

To learn more about Dr. Cotler or to schedule an appointment, please call us on (713) 523-8884.

Howard B. Cotler, MD, FACS, FAAOS is board certified and recertified in Orthopedic Surgery. He is a fellow of the American Academy of Orthopedic Surgery and the American College of Surgeons.

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