Comparison of Spinal Alignment and Mobility in Women With and Without Post Modified Radical Mastectomy Unilateral Lymphoedema

Seyda Toprak Celenay,1 Sevtap Gunay Ucurum,2 Derya Ozer Kaya2. Clinical Breast Cancer 2019

Abstract

Comparison of Spinal Alignment and Mobility in Women With and Without Post Modified Radical Mastectomy Unilateral Lymphoedema

Seyda Toprak Celenay,1 Sevtap Gunay Ucurum,2 Derya Ozer Kaya2. Clinical Breast Cancer 2019.

Unilateral lymphoedema and a resection of the breast may affect spinal alignment and mobility. Twenty women with post modified radical mastectomy unilateral lymphoedema and 18 healthy women were investigated. The sagittal thoracic curvature and the frontal inclination angle were higher in the lymphoedema group in comparison with the control group. The frontal inclination angle changed towards the unaffected side. No difference was observed for spinal mobility.

Introduction: Unilateral lymphoedema and breast resection after modified radical mastectomy might create impairment of spinal alignment and mobility. The aim of this study was to compare spinal alignment and mobility in women with and without post modified radical mastectomy unilateral lymphoedema.

Materials and Methods: Twenty women with post modified radical mastectomy unilateral lymphoedema (lymphoedema group) and 18 healthy women (control group) were included in this study. The sagittal and frontal spinal alignment and mobility were assessed with a Spinal Mouse (Idiag, Fehraltorf, Switzerland). The severity of the lymphoedema was evaluated with circumferential measurements.

Results: In the lymphoedema group, the volume difference of the arms was 448.31  78.14 mL, known as moderate severity lymphoedema. It was seen that the sagittal thoracic curvature (P ¼ .017) and the frontal inclination angle (P ¼ .048) were higher in the lymphoedema group in comparison with the control group. In the lymphoedema group, the frontal inclination angle changed towards the unaffected side (P < .001). No significant differences were found between groups in the other parameters related to spinal curvature and mobility (P > .05).

Conclusion: The sagittal thoracic curvature and the frontal inclination angle towards the unaffected side increased in women with post modified radical mastectomy unilateral lymphoedema. The sagittal and frontal spinal alignment changes should be taken into consideration for the assessment and the treatment of unilateral lymphoedema.

Main findings

  • Women who have undergone mastectomy exhibit a tendency for more prominent thoracic kyphosis.
  • N = 20 between 30 and 60 years diagnosed with secondary arm lymphoedema undergoing unilateral modified radical mastectomy were evaluated for the lymphoedema group.
  • N = 18 healthy group.
  • Compared with controls, women with post modified radical mastectomy unilateral lymphoedema had higher sagittal thoracic curvature and frontal inclination angle. In addition, the frontal inclination angle changed towards the unaffected side in women with unilateral lymphoedema.
  • One of the major physiological problems was considered as a loss of body integrity.
  • Disturbances of the bony points were observed for the shoulder heights, the twist of the pelvis, and the deviation of vertebrae spinous from the vertical line.
  • No significant relationship between the quality of body posture and oncologic treatment was found.
  • Spinal alignment, posture impairments, soft tissue fibrosis, pain, and joint limitations may affect tissue mobility. This study also investigated the segmental spinal mobility adaptations. As a result of the examination of the sagittal and frontal planes of spinal mobility, it was found that thoracic mobility decreased, and lumbar and sacral mobility increased.
  • The study had some limitations.
    • First of all, they did not investigate patients according to their lymphoedema severity and the location of lymphoedema.
    • Second, pain severity, limitation in shoulder movements, having radiotherapy and chemotherapy, the type of surgery, surgery timing, and duration and location of edema all might affect the results.
    • Third they did not have patients who had unilateral mastectomy without lymphoedema in this study. Thus, further studies should be taken into account for this condition.

Clinical Practice Points

  • Unilateral lymphoedema and a resection of the breast after modified radical mastectomy may change body posture. However, the changes in different planes of the spine and mobility impairments have not been well-documented.
  • The sagittal thoracic curvature (kyphosis) and the frontal inclination angle towards the unaffected side increased in women with post modified radical mastectomy unilateral lymphoedema, which may further create scoliosis, balance disorders, thoracic cage mobility, and pulmonary function problems.
  • Spinal mobility changes were observed; however, no difference was found. Clinicians should be aware.
  • Sagittal and frontal spinal alignment changes should be taken into consideration for the rehabilitation.
  • To prevent poor posture and to promote body acceptance and spinal alignment, especially in the presence of lymphoedema, routine follow-up, early rehabilitation, and immediate reconstruction could be considered.
  • Future studies should focus on lymphoedema severity, long-term follow-up, and further functional disorders.