Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Bulging ve Protrüzyon Evrelerindeki Lomber Disk Hernilerinde Ağrı, Multifidus Kas Volümü, Depresyon ve Fonksiyonel Düzeyin Karşılaştırılması
Comparison of Pain, Multifidus Muscle Volume, Depression and Functional Level in Bulging and Protruded Lumbar Disc Herniation
Sedef YILDIRIMALPa, Filiz EYÜBOĞLUa, Yıldız ERDOĞANOĞLUa, Hamza ŞAHİNb, Hanife DÜZGÜN ÇELİKc
aÜsküdar Üniversitesi Sağlık Bilimleri Fakültesi, Fizyoterapi ve Rehabilitasyon Bölümü, İstanbul, TÜRKİYE
bÖzel Kocaeli Hastanesi, Radyoloji Kliniği, Kocaeli, TÜRKİYE
cKonak Hastanesi, Fiziksel Tıp ve Rehabilitasyon Kliniği, Sakarya, TÜRKİYE
Turkiye Klinikleri J Health Sci. 2020;5(2):228-35
doi: 10.5336/healthsci.2019-70600
Article Language: TR
Full Text
ÖZET
Amaç: Bu çalışmanın amacı, bulging ve protrüze evredelerdeki L5-S1 seviye lomber disk hernisi tanılı hastalarda, akut ağrı, multifidus kas volümü, depresyon ve fonksiyonel düzeyi karşılaştırmaktır. Gereç ve Yöntemler: Çalışmaya, 18-65 yaş aralığında 30 disk hernisi tanılı gönüllü hasta dâhil edildi. Hastalar, manyetik rezonans görüntüleme (MRG) sonuçlarına göre bulging ve protrüzyon evre disk hernili grup olmak üzere 2 gruba ayrıldı. Hastaların ağrı şiddetleri, Sayısal Derecelendirme Ölçeği ve Mcgill-Melzack Ağrı Anketi ile lomber multifidus kas kesit alanları MRG üzerinden DICOM Browser programı aracılığıyla ruhsal durumları Beck Depresyon Ölçeğiyle ve fonksiyonel düzeyleri, Roland Morris Engellilik Anketiyle değerlendirildi. Bulgular: Bulging evre ve protrüzyon evre lomber disk hernili hastalar arasında, akut ağrı, multifidus kas volümü, depresyon ve fonksiyonel düzey bakımından istatistiksel olarak anlamlı fark bulunmadı. Sonuç: Çalışma sonuçları, bulging evre ve protrüzyon evrelerdeki disk hernili hastalarda, ağrı şiddeti, multifidus kas volümü, depresyon, fonksiyonel düzey arasında fark göstermedi. Ancak her iki gruptaki hastaların fonksiyonel düzeylerinin azaldığı görüldü. Lomber disk hernisine bağlı akut bel ağrısının, fiziksel ve psikososyal sonuçları önemli bir halk sağlığı sorunu olarak karşımıza çıktığı ve iş kaybı nedeni olarak düşünüldüğünde, sonuçlarımız, bu hasta grubunda fonksiyonelliği artırmaya yönelik uygulamaların erken dönemde, mevcut rehabilitasyon programlarına eklenmesinin önemini vurgular niteliktedir.

Anahtar Kelimeler: Bel ağrısı; vertebralar arası disk; depresyon
ABSTRACT
Objective: This study aimed to compare acute pain, multifidus muscle volume, depression and functional volume in patients diagnosed with bulging and protruded L5-S1 lumbar disc herniation. Material and Methods: 30 volunteered patients with disc herniation whose age varied between 18-65 years were included in the study. The patients were divided into two groups of bulging and protruded disc hernia according to the results of magnetic resonance imaging (MRI). Patients' pain levels were evaluated with the Numeric Rating Scale and McGill-Mezack Pain Questionnaire, cross-sectional areas of their lumbal mutifidus muscle with DICOM Browser program via MRI, their mental status with Beck Depression Inventory, and their functional levels with Roland Morris Disability Questionnaire. Results: No statistically significant differences were found between the patients with bulging and protruded lumbar disc herniation by acute pain, multifidus muscle volume, depression, and functional level. Conclusion: According to the study results, there were no significant differences between the the patients with bulging and protruded lumbar disc herniation by pain level, multifidus muscle volume, depression, and functional level. Nevertheless, a decrease was observed in the functional levels of both groups. Given that acute back pain associated with lumbar disc herniation is an important public health problem with physical and psychosocial results and is a cause of job loss, it is critical to include practices for improving the functionality of this patient group in the current rehabilitation programs in the early stage.

Keywords: Low back pain; intervertebral disc; depression
REFERENCES:
  1. Alper S. [Lumbar disc herniation]. Turkiye Klinikleri J PM&R-Special Topics. 2011;4(1):32-43.
  2. Karababa AO. [Epidemiology of low back pain]. Turkiye Klinikleri J Neurosurg-Special Topics. 2010;3(1):1-7.
  3. Battié MC, Videman T, Gibbons LE, Manninen H, Gill K, Pope M, et al. Occupational driving and lumbar disc degeneration: a case-control study. Lancet. 2002;360(9343):1369-74. [Crossref] 
  4. Strömqvist F, Strömqvist B, Jönsson B, Karlsson M. Gender differences in patients scheduled for lumbar disc herniation surgery: a national register study including 15,631 operations. Eur Spine J. 2016;25(1):162-7.[Crossref]  [PubMed] 
  5. Baltacı G, Bayrakçı Tunay V, Tuncer A, Ergun N. Spor Yaralanmalarında Egzersiz Tedavisi. Ankara: Alp Publications; 2003. p.382.
  6. Dönmez YC, Dolgun E, Kabataş M, Özbayır T. [Investigation of risk factors in patients with lumbar disc hernia]. Fırat University Health Sciences Medical Journal. 2010;24(2):89-92.
  7. Schoenfeld A, Weiner KB. Treatment of lumbar disc herniation. Evidence-based practice. Int J Gen Med. 2010;21;3:209-14.[Crossref]  [PubMed]  [PMC] 
  8. Güçlü DG, Şenormancı Ö, Gönüllü O, Çırak M, Şenormancı G, Köktürk F, et al. [Fear avoidance beliefs and quality of life after lumbar disc surgery]. JCBPR. 2017;6(1):1-8. [Crossref] 
  9. Grobois M. The American congress of rehabilitation medicine: where do we go from here? Arch Phys Med Rehabil. 2003;84(8):1097-9.
  10. Yazıcı K, Tot Ş, Biçer A, Yazıcı A, Buturak V. [Anxiety, depression and quality of life in patients with lowback pain and neck pair]. Turkish J Clinical Psychiatry. 2003;6:95-101.
  11. Mok LC, Lee IF. [Anxiety, depression and pain intensity in patients with low back pain who are admitted to acute care hospitals]. J Clin Nurs. 2008;17(11):1471-80. [Crossref]  [PubMed] 
  12. Pereira MG, Roios E, Pereira M. Functional disability in patients with low back pain: the mediator role of suffering and beliefens about pain control in patients receiving physical and chiropractic treatment. Braz J Phys Ther. 2017;21(6):465-72.[Crossref]  [PubMed]  [PMC] 
  13. Hides J, Stanton W, Dilani Mendis M, Sexton M. The relationship of transversus abdominis and lumbar multifidus clinical muscle tests in patients with chronic low back pain. Man Ther. 2011;16(6):573-7. [Crossref]  [PubMed] 
  14. Sarı Z, Şener G, Yakut Y, Polat MG, Horoz H, Arman A, et al. [Effect of high voltage pulsed current on pain and strength of back muscles in patients with back problems: a randomized controlled study]. Journal of Physiotherapy Rehabilitation. 2010;21(3):101-7.
  15. Alıcıoğlu B, Kabayel DD, Süt N, Emen S. [Detection of the lipoatrophy of lumbar paraspinal muscles semi quantitatively ın patients with low back pain by TSE-T2W MR sequence]. İnönü University Faculty of Medicine. 2008;15(1):9-14.
  16. Wallwork TL, Stanton WR, Freke M, Hides JA. The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle. Man Ther. 2009;14(5):496-500. [Crossref]  [PubMed] 
  17. Erdoğanoğlu Y, Kerem Günel M, Çetin A. [Investigation of the effectiveness of different exercise applications in women with chronic low back pain]. Turkish Journal of Physiotherapy Rehabilitation. 2012;23(3):125-36.
  18. Masaryk TJ, Ross JS, Modic MT, Boumphrey F, Bohlman H, Wilber G, et al. Highresolution MR imaging of sequestered lumbar intervertebral disks. AJR Am J Roentgenol. 1988;150(5):1155-62. [Crossref]  [PubMed] 
  19. Acar K, Acar H, Demir F, Aslan Eti F. [Determining the indicence of postsurgical pain and amount of analgesic use postsurgical pain and analgesic]. Acıbadem Univ J Health Sci. 2016;7:85-91.
  20. Akın Takmaz S. [Approach and evaluation methods for patients with chronic back and neck pain]. TOTBİD Derg. 2017;16:81-8.[Crossref] 
  21. Güngör Tavşanlı N, Özçelik H, Karakovan A. [Examine of quality of life of elderly indivudals suffering pain]. Ağrı. 2013;25(3):93-100. [Crossref]  [PubMed] 
  22. Kuğuoğlu S, Aslan FE, Olgun N. [Turkish version of the McGill-Melzack Pain Questionnaire Form (MPQF)]. Ağrı. 2003;15(1):47-51.
  23. Aktürk Z, Dağdeviren N, Türe M, Tuğlu C. [The reliability and validity analysis of the Turkish version of beck depression inventory for primary care]. Turkish Journal of Family Practice. 2005;9(3):117-22.
  24. Hisli N. [A study on the validity of Beck Depression Inventory]. J Psychol. 1988;6(22):118-26.
  25. Roland M, Morris R. A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine (Phila Pa 1976). 1983;8(2):141-4. [Crossref]  [PubMed] 
  26. Küçükdeveci AA, Tennat A, Elhan AH, Niyazioğlu H. Validation of the Turkish version of the Roland-Morris Disability Questionnaire for use in low back pain. Spine (Phila Pa 1976). 2001;15;26(24):2738-43.[Crossref]  [PubMed] 
  27. Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, DeCuyper HJ. CT imaing of trunk muscles in chronic low back pain patiens and healty control subjects. Eur Spine J. 2000;9(4):266-72. [Crossref]  [PubMed]  [PMC] 
  28. Hides J, Gilmore C, Stanton W, Bohlscheida E. Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther. 2008;13(1):43-9. [Crossref]  [PubMed] 
  29. Faur C, Patrascu JM, Haragus H, Anglitoiu B. Correlation between multifidus fatty atrophy and lumbar disc degeneration in low back pain. BMC Musculoskelet Disord. 2019;5;20(1):414. [Crossref]  [PubMed]  [PMC] 
  30. Kang JI, Kim SY, Kim JH, Bang H, Lee IS. The location of multifidus atrophy in patients with a single level, unilateral lumbar radiculopathy. Ann Rehabil Med. 2013;37(4):498-504. [Crossref]  [PubMed]  [PMC] 
  31. Hyun JK, Lee JY, Lee SJ, Jeon JY. Asymmetric atrophy of multifidus muscle in patients with unilateral lumbosacral radiculopathy. Spine (Phila Pa 1976). 2007;1;32(21):E598-602.[Crossref]  [PubMed] 
  32. Boyacı A, Tutoğlu A, Boyacı N, Dokumacı DŞ. [MRI evaluation of fatty degeneration of paravertebral muscles in the patients with lumbar disc herniation with nerve root compression]. J PMR Sci. 2015;18:7-12.
  33. Barker KL, Shamley DR, Jackson D. Changes in the cross-sectional area of multifidus and psoas in patients with unilateral back pain. Spine (Phila Pa 1976). 2004;15;29(22):E515-9. [Crossref]  [PubMed] 
  34. Freeman MD, Woodham MA, Woodham AW. The role of the lumbar multifidus in chronic low back pain: a review. PM R. 2010;2(2):142-6. [Crossref]  [PubMed] 
  35. Ay S, Evcik D. [Depression and quality of life in patients with chronic low back pain]. Yeni Tıp Dergisi. 2008;25(4):228-31.
  36. Taylor SJ, Taylor AE, Foy MA, Fogg AJ. Responsiveness of common outcome measures for patients with low back pain. Spine (Phila Pa 1976). 1999;1;24(17):1805-12. [Crossref]  [PubMed] 
  37. Kokino S, Özdemir F, Tuna H. [Effect of biofeedback, exercise, biofeedback + exercise treatments on beck depression scale for chronic low back pain cases]. Ağrı. 1999;11:141.
  38. Takahashi N, Kikuchi S, Konno S, Morita S, Suzukamo Y, Green J, et al. Discrepancy between disability and the severity of low back pain: demographic, psychologic and employment-related factors. Spine (Phila Pa 1976). 2006;15;31(8):931-9. [Crossref]  [PubMed] 
  39. Dündar Ü, Solak Ö, Demirdal Ü, Toktaş H, Kavuncu V. [Relation of pain, disability and depression with quality of life in patients with chronic low back pain]. Journal of General Medicine. 2009;19(3):99-104.

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