Dynamic balance in patients with degenerative lumbar spinal stenosis; a cross-sectional study

Abstract

BackgroundDegenerative lumbar spinal stenosis (LSS) is a prevalent condition in adults over the age of 55 years. The condition is associated with activity limitations that are related to increased pain when engaging in weight-bearing activities, such as walking and standing, and release of pain while sitting down or bending forward. The limitation on ambulation is also associated with impaired balance although the types of balance problems are sparsely described in this patient group. The purpose of this study was to assess dynamic balance in persons with LSS by the Mini-BESTest and explore the associations with self-reported balance and functional disability.MethodsSixty two participants were included in this cross-sectional study. The main outcome measure was the Mini-BESTest, providing a total score and sub-scores for 4 balance control systems (Anticipatory Adjustment, Reactive Response, Sensory Orientation, Stability of Gait). The Swiss Spinal Stenosis Questionnaire provided sub-scores for self-reported balance problems and walking function (FUNC).ResultsThe participants showed large inter-individual variation in all measures of balance. The Mini-BESTest score ranged from very good to poor and the mean value was 22.8 (SD 3.5). Nineteen participants (31%) reported having frequent balance problems. Logistic regression analyses showed that both the total Mini-BESTest score (OR (95% CI) 1.6 (1.2, 2.0)(P = .001) and 3 of the 4 balance control systems (Anticipatory Adjustment, Sensory Orientation, Stability in Gait) were significantly associated with self-reported balance problems (.001 ≤ P ≤ .01). The strongest association was seen between Sensory Orientation and balance problems, implying that it is 4.4 times more likely that persons would have no or occasional balance problems with each unit of increase in Sensory Orientation. The total score for the Mini-BESTest was significantly associated with FUNC (P = .042).ConclusionsThe dynamic balance of persons with LSS showed a large heterogeneity with a large fraction of the participants displaying no balance impairments. The test results were associated with the participants’ self-reported balance problems and walking function. The Mini-BESTest thus appears to provide additional information to self-reported disability, and by identifying different kind of balance control impairments, the Mini-BESTest could be useful for physiotherapists working with person-centered rehabilitation in persons with LSS.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2111-x) contains supplementary material, which is available to authorized users.

Percutaneous endoscopic ventral facetectomy: An innovative substitute of open decompression surgery for lateral recess stenosis surgical treatment?

“…[ 3 ] Nevertheless, accompanying symptoms as low back pain, paresthesias, and/or gait limitations may be present. [ 1 2 3 4 ] The conjunction of open decompression with fusion has been proposed as an efficient solution for surgery-related low back pain recession, in order to accomplish a more favorable postoperative clinical course. [ 23 ]…”

“…[ 2 ] Degenerative LSS is associated with particular pathologic alterations in facet joints, posterior longitudinal ligament, or ligamentum flavum, alongside constituting a frequent disorder and the most banal indication for surgery in older adults. [ 3 4 ] LSS is traditionally classified into three different anatomic types: central stenosis (CS), lateral recess stenosis (LRS), or foraminal stenosis (FS), with particular clinical significance. [ 3 5 6 ]…”

Visual Verticality Perception in Spinal Diseases: A Systematic Review and Meta-Analysis

“…In addition to pain, ocular and head motion impairments, dizziness, and unsteadiness are frequent complaints in patients with spinal diseases such as neck pain [ 15 ]. Balance impairment has been found to be common among patients with spinal diseases [ 16 , 17 ]. For example, a distortion of body balance and body postural control has been described in patients with a variety of neck injuries [ 18 ] probably due to a mismatch of the proprioceptive, visual, and vestibular afferent information needed to maintain proper balance [ 19 ].…”

Analysis of Dynamic Plantar Pressure before and after the Occurrence of Neurogenic Intermittent Claudication in Patients with Lumbar Spinal Stenosis: An Observational Study

“…Impaired balance in patients with LSS has been demonstrated in multiple studies. Aleksandra et al [29] and Elisabeth [30] et al conducted studies on the static and dynamic balance functions of patients with LSS, respectively, and confirmed that these patients had a higher risk of falling compared with ordinary subjects. Based on the aforementioned studies, the causes of changes in the gait cycle and plantar pressure distribution in patients with LSS were further analyzed in this study.…”

“…Further studies are needed to explore the effects of spinal stenosis in different segments on the plantar pressure distribution of patients. However, previous gait analysis was performed on the selected patients with L4-L5 level stenosis [11,30,31]. Therefore, patients with LSS with spinal stenosis of other levels or multiple segments were not included in the experimental group, that is, the sample size was small.…”