Slump Sitting X-ray of the Lumbar Spine Is Better Than Conventional Flexion View

Study Overview
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Brief Summary
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This is a prospective, single-blinded, randomized-controlled study comparing a new method (slump-sitting) with the conventional method (forward erect bending) of performing lumbar spine flexion X-rays.

Detailed Description
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Power calculation was performed based on preliminary pilot results using a clinically set difference of 10 degrees (SD 15 degrees) change in mean global lumbar spine flexion between sitting and standing postures. An estimated sample population of 100 patients was deemed necessary for this study to fulfill a statistical power of 90% and a two-sided 5% significance level. Block randomization of every 4 subjects was performed at the beginning of the study to ensure equal numbers of subjects in both study arms for comparison and these results were concealed in envelopes. During the clinical consult, history taking was performed as per a usual clinic visit. Specific patient's details including age, occupation, presence and severity of back pain, presence and severity of leg pain, and neurological symptoms were documented. Physical examination was performed accordingly and parameters such as clinical range of motion of the lumbar spine, neurological signs and provocative tests were recorded for later analysis. For the flexion radiographs, both the new and conventional methods were performed on each patient. These pictures were made into charts and visually displayed. They serve as instructional manuals for patients during the radioimaging process, which are again reinforced with verbal instructions from the on-duty radiographers. Both images were done with the X-ray beam projected from the patients's left and at a distance of 100cm from the patient. The central beam was directed at the estimated centre of L3, with T11 vertebral body and mid-body of the sacrum serving as superior and inferior limits respectively. A single extension view of the lumbar spine was also performed after these flexion views. All radiographs were stored on Digital Imaging and Communications in Medicine (DICOM) format and viewed with Centricity Enterprise Web V3.0 (8.0.1400.128) for assessment. Measurements were done by 2 independent reviewers and an average of their readings was recorded. Both reviewers were blinded to the method in which flexion X-rays was taken. Interim data analysis is planned at 30th patient and the 60th patient. During this time point, the primary objective which look at mean global lumbar spine flexion between sitting and standing postures is assessed. All collected data and measurements were tabulated using Microsoft Excel 2011(Version 14.0 (32-bit)) and analyzed using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS Version 23.0). For the main analysis of both global and segmental lumbar flexion, as well as the measured displacements obtained between the two flexion methods, paired t-test was employed. There is no requirement to follow up the patients in this study. The whole study is to be completed within 1 year of recruitment

Official Title
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Slump Sitting X-ray of the Lumbar Spine Is Better Than Conventional Flexion

Conditions
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Low Back Pain, Spondylolisthesis

Intervention / Treatment
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* Radiation: Slump sitting
* Radiation: Forward bending


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients above 45 years of age; With mechanical low back pain, With spondylolisthesis Physically able to position themselves correctly for both methods of X-rays Exclusion Criteria: Previous spinal interventions Suspected findings for spinal malignancies, spinal trauma, and inflammatory spinal diseases Pregnant women

Ages Eligible for Study
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Minimum Age: 45 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Slump sitting<br>Slump sitting flexion of lumbar spine | Radiation: Slump sitting<br>* Patients are asked to sit slumped on the chair as much as possible without leaning forwards, and place you hands below your thighs.<br>|
| Active Comparator: Forward bending<br>Forward erect bending of lumbar spine | Radiation: Forward bending<br>* Patients are asked to stand with both feet placed together, hands behind their heads, and bend forward in this position as much as possible without falling<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Global lumbar spine flexion range of motion | Change in mean global lumbar spine flexion between sitting and standing postures | Day 1 (no follow-up, outcome assessed immediately) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Segmental lumbar spine flexion range of motion | Change in segmental global lumbar spine flexion between sitting and standing postures | Day 1 (no follow-up, outcome assessed immediately) | 
| Segmental translational changes during lumbar spine flexion | Percentage translation at each segmental lumbar spine levels | Day 1 (no follow-up, outcome assessed immediately) |