Differential diagnosis of dorsopathies in pregnancy

• Elena V. Radzinskaya

Abstract

The aim of this study - differentiation of clinical and anamnestic criteria for dorsopathy of pregnant women of different localization.

Material and methods. A prospective multicenter study conducted. Period: 2019-2020. 87 pregnant women were included: 48 with lower back pain (LBP), 39 with pelvic girdle pain (PGP). Pain, discomfort/pain, the level of personal and situational anxiety, and health in general were evaluated before and after treatment. Dorsopathies were treated at a gestational age >22 weeks. Approaches used in treatment: physical therapy, acupuncture, manual techniques (craniosacral therapy, traction method, myofascial release, post-isometric relaxation, soft tissue techniques).

Results. A method of differential diagnosis of dorsopathies has been developed for LBP (M54.3 and M54.4 according to ICD-X) and PGP (M54.5 according to ICD-X), which is based on reliable signs of differences between these diseases. Thus, PGP is characterized by a large number of injuries of any localization and severity in the anamnesis (OR=3.9; 95% CI 1.49-10.24), while for LBP, the leading signs were a lower level of the beta subunit of chorionic gonadotropin in the blood, a lower location of the placenta edge, but a superior length of the cervix. An important generalizing feature of dorsopathies is the almost complete absence of association with undifferentiated connective tissue dysplasia: none of the examined patients with the established diagnosis of dorsopathy had dysplasia stigmas. The pain syndrome assessed on a numerical rating scale, comparable before the start of treatment, remained higher at the end of treatment with LBP (4.71±0.76 and 0.65±1.03 points, p<0.01), predictably worsening the assessment of health, discomfort/pain, anxiety/depression (p<0.05). The effect of endogenous and exogenous progesterone and its metabolites on dorsopathy remained unclear. Pregnant women with LBP were distinguished from PGP by an increased chance of fixation of the Dura mater in the cervical spine (OR=3,3; 95% CI 1.16-9.41). Craniosacral rhythm was significantly higher for PGP (7.85±1.73 and 7.00±1.24, p=0.01).

Conclusion. Differences between pregnant women with PGP and LBP were established. The pain syndrome in LBP is stopped less effectively than PGP. The gestational determinism of dorsopathy (both PGP and LBP) is confirmed by correlations between general clinical, neurological, ultrasound, laboratory, osteopathic, and psychological parameters, reflecting the versatility of its pathogenesis.

Keywords:dorsopathy, pregnancy, lower back pain, pelvic girdle pain, osteopathy, craniosacral rhythm, fixation of the dura mater, sacrum counternutation

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