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Santos A, Silva MF, Dos Santos EH, Tassiana Silva C, Obara K, Bonilha Oda S, Carrasco AC, Cardoso JR. Gait analysis of individuals with specific low back pain undergoing surgery: case series report with one and six-month follow-up. Physiother Theory Pract 2024; 40:1635-1645. [PMID: 36892481 DOI: 10.1080/09593985.2023.2187267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/10/2023]
Abstract
INTRODUCTION In addition to pain, specific low back pain is frequently accompanied by restricted range of motion (ROM) during gait. PURPOSE To compare the behavior of kinematic and spatiotemporal gait parameters, pain, functional status, and self-efficacy, in patients with a diagnosis of herniated disk or lumbar stenosis undergoing surgery, in the pre- and postoperative periods of 1 and 6 months (PO6). METHODS Seven participants and 11 control subjects were assessed. A kinematics system comprising 10 optoelectronic cameras was used to assess gait. The Roland-Morris questionnaire, pain intensity, and self-efficacy, over three periods, were used. RESULTS The ROM of the pelvis, hip, and knee of the hernia group presented an increase after surgery and the stenosis group presented a reduction of values in the hip. During the stance phase, the pelvis and hip ROM of both groups remained smaller than the control group. There was improvement in pain in individuals with hernia and stenosis (effect size = 0.6 and 0.8, respectively) in the three analyzed moments; for functional status there was improvement in the first postoperative period (ES = 0.4) compared to the preoperative in those individuals with hernia; and those with stenosis had improvement at PO6 when compared to the time before the surgery (ES = 0.2). CONCLUSION Surgical intervention modifies the spatiotemporal parameters, the ROM of the pelvis, hip, and knee in the total gait cycle, primarily in the sagittal plane, and causes alterations, particularly in the hip joint, in these individuals during the support phase.
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Affiliation(s)
- Amanda Santos
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Mariana Felipe Silva
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Eduarda Hirle Dos Santos
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Carla Tassiana Silva
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Karen Obara
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Shigueo Bonilha Oda
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Aline Cristina Carrasco
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
- PT Department, Universidade Estadual do Centro-Oeste, Guarapuava, PR, Brazil
| | - Jefferson Rosa Cardoso
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
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Wang F, Wang R, Zhang C, Song E, Li F. Clinical effects of arthroscopic-assisted uni-portal spinal surgery and unilateral bi-portal endoscopy on unilateral laminotomy for bilateral decompression in patients with lumbar spinal stenosis: a retrospective cohort study. J Orthop Surg Res 2024; 19:167. [PMID: 38444008 PMCID: PMC10916320 DOI: 10.1186/s13018-024-04621-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/11/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE To investigate the clinical effectiveness of Arthroscopic-assisted Uni-portal Spinal Surgery (AUSS) in the treatment of lumbar spinal stenosis. METHODS A total of 475 patients with lumbar spinal stenosis from January 2019 to January 2023 were included in this study. Among them, 240 patients were treated with AUSS (AUSS group); the other 235 patients were treated with unilateral bi-portal endoscopy treatment (UBE group). The differences in surgery-related clinical indicators, pain degree before and after surgery, Oswestry Disability Index (ODI), CT imaging parameters of spinal stenosis, and clinical efficacy were compared between the two groups. RESULTS Patients in the AUSS group had a shorter operative time than those in the UBE group, and the length of incision and surgical bleeding were less than those in the UBE group, with statistically significant differences (P < 0.05). Before operation, there was no significant difference in the VAS score of low back pain and leg pain between the two groups (P > 0. 05). After operation, patients in both groups showed a significant reduction in low back and leg pain, and their VAS scores were significantly lower than before the operation (P < 0.05). Three months after surgery, the results of CT re-examination in both groups showed that the spinal stenosis of the patients was well improved, and the measurements of lumbar spinal interspace APDC, CAC, ICA, CAD and LAC were significantly higher than those before surgery (P < 0. 05). Besides, the lumbar function of patients improved significantly in both groups, and ODI measurements were significantly lower than those before surgery (P < 0.05). CONCLUSION Both AUSS and UBE with unilateral laminotomy for bilateral decompression can achieve good clinical results in the treatment of lumbar spinal stenosis, but the former has the advantages of simpler operation, shorter operation time, shorter incision length, and less surgical blood loss.
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Affiliation(s)
- Fang Wang
- Department of Orthopaedics, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Rui Wang
- Department of Orthopaedics, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Chengyi Zhang
- Department of Orthopaedics, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - En Song
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
| | - Fengtao Li
- Department of Orthopaedics, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China.
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Chapon R, Alixant P, Laroche D, Ornetti P, Beaurain J, le Van T, Berhouma M, Ricolfi L. Influence of Posture on Gait Parameters in Severe Symptomatic Lumbar Stenosis Before and After Decompression Surgery. World Neurosurg 2024; 183:e109-e115. [PMID: 38030072 DOI: 10.1016/j.wneu.2023.11.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND We searched to quantify the influence of sagittal vertical axis (SVA) on the improvement of spatiotemporal gait parameters using a gait motion analysis (GMA) before and after decompression surgery in patients suffering from lumbar spinal stenosis (LSS). METHODS Thirty-nine patients with severe LisSS planned for lumbar decompression underwent a full-body biplanar radiographs (EOS) to quantify the SVA and have benefited from a 3-dimensional GMA 1 month before surgery (M0) and 6 month (M6) after surgery. The first step of this study was to confirm the validation of 3-dimensional sagittal vertical axis (3D SVA) for posture analysis. An analysis of modification of the 3D SVA and spatiotemporal gait parameters was then carried out in order to identify any correlation. RESULTS Decompression surgery did not significantly improve 3D SVA between M0 and M6 (respectively 49.1 [50.3] vs. 49.84 [19.02], P = 0.42). Concerning spatiotemporal parameters, we found significant difference for all parameters between M0 and M6. A strong correlation (R2 > 0.65) between static SVA (EOS) and 3D SVA was demonstrated using a statistical regression equation. There was also a statistically significant correlation between SVA (static and 3-dimension) and improvement in spatiotemporal gait parameters after decompression surgery. CONCLUSIONS This study analyses the relationship between postural change (SVA) and improvement in gait parameters measured during GMA before and after decompression surgery for LSS. This specific analysis of gait parameters may represent a prognostic assessment tool for the recovery of patients undergoing surgery for a LSS.
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Affiliation(s)
- Renan Chapon
- Department of Neurosurgery, University Hospital of Dijon Burgundy, Dijon, France
| | - Philibert Alixant
- Department of Neurosurgery, University Hospital of Dijon Burgundy, Dijon, France.
| | - Davy Laroche
- CIC INSERM 1432, Technological Investigation Platform, University Hospital of Dijon Burgundy, University of Burgundy, Dijon, France
| | - Paul Ornetti
- CIC INSERM 1432, Technological Investigation Platform, University Hospital of Dijon Burgundy, University of Burgundy, Dijon, France; Department of Rheumatology, University Hospital of Dijon Burgundy, Dijon, France
| | - Jacques Beaurain
- Department of Neurosurgery, University Hospital of Dijon Burgundy, Dijon, France
| | - Tuan le Van
- Department of Neurosurgery, University Hospital of Dijon Burgundy, Dijon, France
| | - Moncef Berhouma
- Department of Neurosurgery, University Hospital of Dijon Burgundy, Dijon, France; Functional and Molecular Imaging Team (CNRS 6302 - ICMUB), Molecular Chemistry Institute, University of Burgundy, Dijon, France
| | - Louis Ricolfi
- Department of Orthopaedic surgery, University Hospital of Dijon Burgundy, Dijon, France
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Na CH, Siebers HL, Reim J, Eschweiler J, Hildebrand F, Clusmann H, Betsch M. Kinematic movement and balance parameter analysis in neurological gait disorders. J Biol Eng 2024; 18:6. [PMID: 38225612 PMCID: PMC10790442 DOI: 10.1186/s13036-023-00398-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/07/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Neurological gait disorders are mainly classified based on clinical observation, and therefore difficult to objectify or quantify. Movement analysis systems provide objective parameters, which may increase diagnostic accuracy and may aid in monitoring the disease course. Despite the increasing wealth of kinematic movement and balance parameter data, the discriminative value for the differentiation of neurological gait disorders is still unclear. We hypothesized that kinematic motion and balance parameter metrics would be differently altered across neurological gait disorders when compared to healthy controls. METHODS Thirty one patients (9 normal pressure hydrocephalus < NPH > , 16 cervical myelopathy < CM > , 6 lumbar stenosis < LST >) and 14 healthy participants were investigated preoperatively in an outpatient setting using an inertial measurement system (MyoMotion) during 3 different walking tasks (normal walking, dual-task walking with simultaneous backward counting, fast walking). In addition, the natural postural sway of participants was measured by pedobarography, with the eyes opened and closed. The range of motion (ROM) in different joint angles, stride time, as well as sway were compared between different groups (between-subject factor), and different task conditions (within-subject factor) by a mixed model ANOVA. RESULTS Kinematic metrics and balance parameters were differently altered across different gait disorders compared to healthy controls. Overall, NPH patients significantly differed from controls in all movement parameters except for stride time, while they differed in balance parameters only with regard to AP movement. LST patients had significantly reduced ROMs of the shoulders, hips, and ankles, with significantly altered balance parameters regarding AP movement and passed center-of-pressure (COP) distance. CM patients differed from controls only in the ROM of the hip and ankle, but were affected in nearly all balance parameters, except for force distribution. CONCLUSION The application of inertial measurement systems and pedobarography is feasible in an outpatient setting in patients with different neurological gait disorders. Rather than defining singular discriminative values, kinematic gait and balance metrics may provide characteristic profiles of movement parameter alterations in the sense of specific ´gait signatures´ for different pathologies, which could improve diagnostic accuracy by defining objective and quantifiable measures for the discrimination of different neurological gait disorders. TRIAL REGISTRATION The study was retrospectively registered on the 27th of March 2023 in the 'Deutsches Register für Klinische Studien' under the number DRKS00031555.
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Affiliation(s)
- Chuh-Hyoun Na
- Department of Neurosurgery, University Hospital RWTH Aachen, Pauwelsstr. 30, Aachen, 52074, Germany.
| | - Hannah Lena Siebers
- Department of Orthopaedic, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Julia Reim
- Department of Orthopaedic, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Hans Clusmann
- Department of Neurosurgery, University Hospital RWTH Aachen, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Marcel Betsch
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Igawa T, Ishii K, Katsuhira J, Suzuki A, Ui H, Urata R, Isogai N, Sasao Y, Matsudaira K, Funao H. Trunk orthosis with joints providing resistive force improves dynamic sagittal alignment in postoperative patients with lumbar spinal stenosis. Sci Rep 2023; 13:20636. [PMID: 38001133 PMCID: PMC10673938 DOI: 10.1038/s41598-023-46209-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/29/2023] [Indexed: 11/26/2023] Open
Abstract
This study aimed to determine whether a trunk orthosis with joints providing resistive force (TORF) modifies sagittal malalignment during level walking in patients with lumbar spinal stenosis (LSS). Fifteen patients, 6 months after undergoing surgery for LSS, performed level walking at a self-selected speed while wearing a TORF. Dynamic sagittal alignment, including sagittal vertical axis, lumbar lordosis, and pelvic tilt, and spatiotemporal data as well as lower limb kinematic and kinetic data were recorded using a three-dimensional motion analysis system and six force plates. Statistical analysis was performed to compare these data with and without the TORF, respectively. Compared to the condition without the TORF, the use of the TORF significantly decreased positive sagittal vertical axis (p < 0.05) and increased the lumbar lordosis and pelvic tilt (p < 0.05). Peak hip flexion angle and extension moment during loading response (LR) significantly increased (p < 0.05), and peak hip extension angle and flexion moment during PS statistically decreased (p < 0.05). There was no difference in spatiotemporal data between the two conditions. Our findings suggest that TORF may modify the dynamic sagittal global alignment and lower limb kinematic and kinetics in postoperative LSS patients during level walking.
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Affiliation(s)
- Tatsuya Igawa
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita, Chiba, 286-8520, Japan.
- Department of Rehabilitation, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo, 108-8329, Japan.
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, 2600-1, Kitakanemaru, Ohtawara, Tochigi, 323-8501, Japan.
| | - Ken Ishii
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Junji Katsuhira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- Department of Human Environment Design, Toyo University, 1-7-11, Akabanedai, Kitaku, Tokyo, 115-053, Japan
| | - Akifumi Suzuki
- Department of Rehabilitation, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Hideto Ui
- Department of Rehabilitation, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Ryunosuke Urata
- Department of Rehabilitation, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Norihiro Isogai
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Yutaka Sasao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- Department of Pain Medicine, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita, Chiba, 286-8520, Japan
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