Analysis of musculoskeletal complications of spinal column after bilateral lower limb amputation in 335 patients

 Mohammad Hassan Azma ,Hadi Shojaei

OBJECTIVE: Lower limb amputation is one of the massive consequences of the war. According to statistics 70% of the lower limb amputations are due to diabetes mellitus and peripheral vascular disorders, in which the patients suffer from the debilitating disease for years and amputation is to somewhat expected. But war related amputations usually occurs among young people and is unexpected; so pre-amputation rehabilitation and immediate post-amputation rehabilitation are not performed completely and their complications are different from the first group. Identifying the spinal column complications plays an important role in prevention of more disability

MATERIALS-METHODS: of total 400,000 injured people following the Iran-Iraq war, 11570 patients are suffering from lower limb amputation and 578 subjects are bilateral lower limb amputees. During this cross sectional study 335 patients accepted our invitation and attended for the study (winter 2006). A physical medicine and rehabilitation specialist was responsible for all the interviews and examinations and physical exams data showing any symptoms of scoliosis, kyphosis, pelvic malalignment, hyperlordosis and kyphoscoliosis were recorded.
RESULTS: Iliac crest malalignment (pelvic tilt) was the most frequent problem (28.4%) and scoliosis rated as second (4.5%). Hyperlordosis, kyphosis and kyphoscoliosis observed in 0.5%, 0.9% and 0.3%, respectively. Finally statistical analysis of these complications with age, sex, education, level of amputation, employment, place where amputation performed, date and reason for amputation, number of hospitalization periods, and number of amputation surgeries, phantom pain, phantom sensation, spinal column pain, and upper limbs pain were performed.
DISCUSSION: Recognition of spinal column complications such as scoliosis following lower limb amputation are important for planning the rehabilitation programs in order to prevent and treat more properly; rehabilitation procedures for these problems (e.g. scoliosis) are very expensive, it is highly recommended to perform preventive plans to reduce the patients’ suffering and expenditure.

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