gms | German Medical Science

Objective: Degenerative lumbar and cervical spine diseases are often associated with a lot of discomfort. They constitute a main reason for sick certificates in the EU. So far it has not been sufficiently clarified whether patients with lumbar and patients with cervical spine diseases differ regarding the extent of experienced pain-related restrictions, as for e.g. limitations in performing activities of daily living (ADL).

Methods: In a prospective cohort study 261 consecutive patients (58.2% females) were examined with standardized questionnaires at their first appointment in an outpatient clinic. Of the 73 patients with cervical spine diseases 27 suffered from disc herniation and 46 from stenosis/myelopathy. Within the group of 188 patients with lumbar spine diseases, 81 had disc herniation and 107 had lumbar stenosis. Psychometric data were collected regarding pain intensity (VAS), interference of pain with the performance of ADLs (PI-G), execution of ADLs (RehaCAT) and participation in social life (AAPI) as well as regarding depression (DESC) and fear of movement (TSK_GV). The group comparison between patients with lumbar vs. cervical spine diseases was performed using T-tests and effect sizes (ES).

Results: Overall, the patients report a moderate level of impairment with regard to pain intensity and limitations in ADLs. 39.9% of the total sample showed depression values above the clinical cut-off. Significant differences between the two groups were found in pain intensity (VAS: p=0.006, ES=-0.53), everyday mobility (RehaCAT lower extremity function: p=0.000, ES=-0.75; PI-G-physical: p=0.0001, ES=-0.71), activities that simultaneously require upper and lower extremities (RehaCAT activities of everyday life: p=0.022, ES=-0.35), as well as in interference of pain with everyday functioning (PI-G-functional: p=0.009, ES=-0.39). Altogether, patients with lumbar spine diseases report more impairments than patients with cervical spine diseases.

Conclusion: The study highlights that patients with lumbar spine diseases are more affected by pain, especially with regard to the mobility during everyday activities involving the lower extremities. Future studies comparing the pre- vs. post-operative status of the patients will have to investigate whether both groups still differ post-operatively and whether psychometric data being assessed pre-operatively might be used as outcome predictors for the expected post-operative status.