LBP With Restricted Straight-Leg Raise: Is the Anterior Theca to Blame?

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LBP With Restricted Straight-Leg Raise: Is the Anterior Theca to Blame?

The origin of acute mechanical LBP remains a subject of debate. Previous studies provide evidence that LBP associated with restricted straight-leg raising (SLR) may be caused by a central disc prolapse, whereas a lateral prolapse may induce leg pain; however, to the authors' knowledge, no studies have evaluated patients presenting with LBP only and reduced SLR.

This study was designed to determine the anatomical source of pain in a group of patients presenting with acute LBP and a restricted SLR normally associated with leg pain (attributable to a posterolateral disc prolapse). Two groups of 12 patients each - one group with acute LBP only and the other group with acute leg pain only, yet showing similar SLR restrictions - underwent magnetic resonance imaging. A spinal radiologist reviewed all MR scans, and findings were compared between groups.

Results: Eleven of the 12 patients in the LBP-only group were found to have disc protrusions or extrusions on lumbar spine MRI. Disc prolapses in the back pain group "were more likely to be central, smaller, and to compress the theca only, and to be at a higher lumbar level" compared to the leg pain group. The authors conclude that acute LBP associated with significant restriction in straight-leg raising is "likely to be caused by a disc prolapse compressing the anterior theca."

Summers B, Malhan K, Cassar-Pullicino V. Low back pain on passive straight leg raising: the anterior theca as a source of pain. Spine, Feb. 1, 2005;30(3):342-45.