title: Characteristics and exacerbating factors of chronic low back pain in Parkinson's disease.
abstract: BACKGROUND
  The aim of this study was to determine the exacerbating factors of chronic low back pain (LBP) and strategic points against LBP in patients with Parkinson's disease (PD).
  
  
  METHODS
  Forty-four consecutive PD patients complaining of LBP were included. Clinical characteristics of PD and LBP, spinal musculoskeletal condition, and clinical health status were evaluated.
  
  
  RESULTS
  Patient age at PD and LBP onset was contiguous, and LBP time period was mainly described as constant or upon waking up. Exacerbating factors of LBP included modified Hoehn and Yahr stage and motor complications of PD, such as the wearing-off phenomenon and dyskinesia. Bone quality demonstrated osteopenia due to elevated bone resorption, with vitamins K and D insufficiencies. Spinal alignment demonstrated an increased sagittal vertical axis (120.2 ± 65.4 mm) with decreased lumbar lordosis (-24.0 ± 20.6°) and lumbar range of motion (28.7 ± 10.2°), which were significantly related to severity of LBP and quality of life assessments.
  
  
  CONCLUSIONS
  This study demonstrated that exacerbating factors of LBP include stage of motor function, motor complications of PD and stooped posture with decreased lumbar lordosis and range of lumbar movement. Therefore, control of PD, including motor complications, active treatment for osteoporosis and therapeutic exercise, are important for treating chronic LBP in patients with PD.
authors.affiliation: Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan. Keiwatanabe_39jp@live.jp.
authors.forename: Kei
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Hirano
authors.affiliation: Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Katsumi
authors.affiliation: Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohashi
authors.affiliation: Department of Neurology, Brain Disease Center Agano Hospital, Agano City, Niigata, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ishikawa
authors.affiliation: Department of Neurology, Nishi-Niigata Chuo National Hospital, Niigata City, Niigata, Japan.
authors.forename: Ryoko
authors.initials: R
authors.lastname: Koike
authors.affiliation: Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Endo
authors.affiliation: Department of Neurology, Brain Research Institute, Niigata University, Niigata City, Niigata, Japan.
authors.forename: Masatoyo
authors.initials: M
authors.lastname: Nishizawa
authors.affiliation: Department of Neurology, Brain Research Institute, Niigata University, Niigata City, Niigata, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Shimohata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D008161:Lumbosacral Region / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000503:physiopathology*; D011446:Prospective Studies; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000502:physiology; D012307:Risk Factors
keywords: Exacerbation factors; Low back pain; Parkinson’s disease; Quality of life; Spinal alignment