Impact of lower extremity amputation on spinal health: a cohort study of back pathologies in transfemoral and transtibial amputees.

Background: Lower extremity amputation significantly impacts the quality of life for individuals, often leading to a range of complications, including altered biomechanics and increased incidence of low back pain. This study investigates the connection between lower extremity amputation and the development of spinal pathologies, specifically among patients undergoing transtibial amputee (TTA) and transfemoral amputee (TFA). An understanding of the development of specific spinal pathologies following lower extremity amputation would allow for healthcare providers to establish targeted monitoring, treatment and rehabilitation programs for amputees. Methods: Utilizing the PearlDiver database, which includes data from approximately 165 million patients, we conducted a retrospective analysis comparing the prevalence of back pathologies and the frequency of spinal surgeries of TTA and TFA amputees and matched able-bodied control subjects which was based on age, gender, and the Elixhauser comorbidity index (ECI). In both the TFA and control groups 23,079 patients were analyzed while 16,350 patients were analyzed in both the TTA and control group. Matched patient groups resulted in a sample size of 2,457 TFA matched controls and 1,642 TTA matched controls. Odds ratios (ORs) and P values were calculated to assess the associations between amputation status and the incidence of back pathologies and spine surgeries. Results: The findings of this study reveal a markedly higher prevalence of spinal conditions, including low back pain, radiculopathy, sciatica, anterior and posterior lumbar pathologies in amputee populations. Both TFA and TTA patients had higher odds of developing posterior back pathologies compared to controls [TFA OR =1.77, 95% confidence interval (CI): 1.66-1.88, P<0.001; TTA OR =1.74, 95% CI: 1.62-1.88, P<0.001]. Both TFA and TTA patients were found to have increased odds of undergoing lumbar decompressions (TFA OR =1.69, 95% CI: 1.43-2.03, P=0.02; TTA OR =1.30, 95% CI: 1.08-1.56, P=0.01), and lumbar fusions (TFA OR =1.92, 95% CI: 1.58-2.32, P=0.004; TTA OR =1.66, 95% CI: 1.32-2.07, P=0.01). Conclusions: Lower extremity amputees are at a significantly higher risk of developing back pathologies when compared to non-amputee controls. The data suggest that both TFA and TTA face elevated odds of requiring surgical treatment for spinal conditions. These insights underline the critical need for proactive clinical measures, including early and regular monitoring of spine health in amputees.