The proportion of patients with non-specific low back pain and neural compromise

Lack of sensitivity in clinical evaluation and imaging techniques often result in the potential misdiagnosis of the nerve root compromise in patients with non specific low back pain (NSLBP). H-reflex is reliable, valid, and sensitive electrophysiological procedure in detecting neural impingement in patients with low back pain of neurological origin and, thus, could be used to detect nerve root compromise in NSLBP To date, this has not been studied. The purpose of this study was to estimate the proportion of patients with NSLPB and neural compromise using the soleus H-reflex. Soleus H-reflex was measured bilaterally in 30 NSLBP patients with no radicular symptoms during prone lying and standing upright relaxed postures. Five traces were measured and averaged. Side-to-side amplitude (HIH) ratios were then calculated. Inference statistic estimated the proportion and 95% confidence intervals of patients with NSLBP and neural involvement. Soleus H-reflex asymmetry was detected in 17% and 20% of patients with NSLBP during lying and standing, respectively. In some patients, NSLBP may be associated with small degree of nerve root compromise, although the neural compromise is insufficient to cause distal radiculopathy. For these patients, treatment strategies to address such possible underlying mechanism of pain should be considered.