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Research ArticleLumbar Spine

Chronic Low Back Pain Occurring in Association With Hypermobility Spectrum Disorder and Ehlers-Danlos Syndrome

Kelechi C. Eseonu, Kathy Payne, Stephen Ward, Bahram Fakouri and Jaykar R. Panchmatia
International Journal of Spine Surgery May 2021, 8067; DOI: https://doi.org/10.14444/8067
Kelechi C. Eseonu
Guy's and St Thomas' Hospitals, London, England
BSC, MSC, MB CHB, FRCS
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Kathy Payne
Guy's and St Thomas' Hospitals, London, England
BSC
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Stephen Ward
Guy's and St Thomas' Hospitals, London, England
MBBS, FRCA, FFPMRCA
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Bahram Fakouri
Guy's and St Thomas' Hospitals, London, England
MD, FRCS
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Jaykar R. Panchmatia
Guy's and St Thomas' Hospitals, London, England
MA, MPH, MB BCHIR, FRCS
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ABSTRACT

Background This review paper outlines recent advances in diagnostic criteria for hypermobility spectrum disorder (HSD) and its association with Ehlers-Danlos syndrome (EDS), as well as current literature on the association between joint hypermobility syndrome and lumbar back pain. We outline the optimal multidisciplinary management of lumbar back pain in the context of joint hypermobility syndrome, as well as the indications and possible side effects of surgical management of patients with these conditions.

Several studies have suggested a link between chronic low back pain and hypermobility. HSD has been described as an excessive range of motion in a joint, when accounting for patient demographics. The nomenclature surrounding symptomatic joint hypermobility has varied historically, and various groups, including most notably the international EDS consortium, have introduced new classification schemes to acknowledge the systemic effects of joint hypermobility, which were previously poorly understood.

Methods Narrative literature review.

Results Not applicable.

Conclusions Lower back pain experienced in patients on the HSD-EDS spectrum is multifactorial in origin and should not be considered solely in anatomical terms. Caution has been advised in the surgical management of patients on the HSD-hEDS spectrum, particularly where the subtype is unclear. The vascular type of EDS has a particular propensity for severe bleeding complications. Rates of perioperative complications after lumbar spinal surgery in the hypermobile EDS population have been reported to be up to 50%. When hypermobility and chronic lumbar back pain coexist, we advocate management in a multidisciplinary setting involving physiotherapists, pain physicians, surgeons, and psychologists.

  • joint hypermobility syndrome
  • Ehlers-Danlos syndrome
  • lumbar back pain
  • joint hyperlaxity

Footnotes

  • Disclosures and COI: The authors received no funding for this study and report no conflicts of interest.

  • This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2021 ISASS
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International Journal of Spine Surgery: 19 (S2)
International Journal of Spine Surgery
Vol. 19, Issue S2
1 Apr 2025
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Chronic Low Back Pain Occurring in Association With Hypermobility Spectrum Disorder and Ehlers-Danlos Syndrome
Kelechi C. Eseonu, Kathy Payne, Stephen Ward, Bahram Fakouri, Jaykar R. Panchmatia
International Journal of Spine Surgery May 2021, 8067; DOI: 10.14444/8067

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Chronic Low Back Pain Occurring in Association With Hypermobility Spectrum Disorder and Ehlers-Danlos Syndrome
Kelechi C. Eseonu, Kathy Payne, Stephen Ward, Bahram Fakouri, Jaykar R. Panchmatia
International Journal of Spine Surgery May 2021, 8067; DOI: 10.14444/8067
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Keywords

  • joint hypermobility syndrome
  • Ehlers-Danlos syndrome
  • lumbar back pain
  • joint hyperlaxity

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