Dynamic global sagittal alignment in patients with lumbar spinal stenosis: Analysis of the effects of decompression surgery on gait adaptations

Lamas, Vincent; Gueugnon, Mathieu; Fournel, Isabelle; Grelat, Michaël; Maillefert, Jean-Françis; Ornetti, Paul; Martz, Pierre

doi:10.1016/j.gaitpost.2021.05.029

Cited by 6 publications

(5 citation statements)

References 32 publications

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“…Since the compensatory flexed posture helps to reduce discomfort, investigations in the literature indicated that patients with symptomatic DLS have less lumbar lordosis [14]. Similar to our study, Lamas et al [2] showed that the pelvis of DLS patients is more anteverted during gait compared to asymptomatic individuals, and DS appears to result in pelvic retroversion. Additionally, the patients' full range of pelvic motion continued to be unaffected.…”

Section: Discussionsupporting

confidence: 89%

“…In patients 65 years of age and older, the prevalent degenerative disease of degenerative lumbar stenosis (DLS) is the primary reason for spinal surgery [1,2]. DLS is defined by compression of vascular and neurological structures, narrowing of the spinal canal, and impairment, causing symptoms such pain and weakness in the lower limbs [2,3]. Most patients adjust their posture with forward bending in the upright position during gait to reduce pain by lowering the epidural pressure [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Spine-pelvis-lower extremity sagittal alignment might be significantly impacted in patients with DLS. Lamas et al discovered that although the pelvises of DLS patients were considerably more anteverted during locomotion than those of asymptomatic individuals, complete range of motion remained unaffected [2]. As opposed to healthy people, patients with DLS walked with a stiffer pelvis in the transverse plane.…”

Section: Introductionmentioning

confidence: 99%

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Effects Of Decompression Surgery On Pelvic Movements In Patients With Degenerative Lumbar Stenosis

Polat,

Karatay

et al. 2023

Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin

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Objective Pelvic movements when walking should be objectively evaluated in the context of clinical data in order to understand the function of compensatory mechanisms in the onset and management of symptomatic degenerative lumbar stenosis (DLS). The purpose of this study was to compare patients treated with decompression surgery (DS) and patients with symptomatic DLS in terms of pelvic movements while walking. Materials and Methods A total of 107 participants were included in this study. 34 patients who underwent DS performed by the same surgeon were selected as the DS group, while 39 patients with DLS who required surgery were selected as the DLS group. The control group consisted of 34 age-matched healthy individuals who had no disease and no gait disorder. The BTS G-WALK sensor system (G-Walk) was used to measure pelvic movements (tilt, rotation, obliquity) and gait parameters (speed, cadence, stride length). Results DS and control groups had decreased maximum (p=0.008 and p=0.006, respectively) and minimum anterior tilt of the pelvis (p=0.015 and p=0.001, respectively) compared to the DLS group. There was no significant difference between the groups for rotation, oblique and tilt range of motion of the pelvis (p>0.05). Compared to the control group, speed during gait were significantly lower in both the DLS (p=0.012) and DS groups (p=0.016). Conclusions In this study, decompression surgery was found to affect pelvic movements. Patients with DLS walked differently from those who had no symptoms, and this difference usually disappeared following surgical decompression. Pelvic movements may serve as a helpful screening measure to identify early compensatory mechanisms. Key words: lumbar stenosis, pelvic movement, decompression surgery, spine-pelvis lower extremity, sagittal alignment

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effects Of Decompression Surgery On Pelvic Movements In Patients With Degenerative Lumbar Stenosis

Polat,

Karatay

et al. 2023

Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin

View full text Add to dashboard Cite

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“…In addition, elderly patients are often accompanied by some internal medicine diseases such as hypertension, cardiopulmonary dysfunction, and diabetes. These patients often have poor results after conservative treatment and have to choose surgical treatment [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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

Wang,

Zhang

et al. 2024

J Orthop Surg Res

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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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“…In LST patients, kinematic gait analyses showed differences in spinal and pelvic movement, and aided to quantify movement deviations compared to healthy controls [ 24 , 25 ]. Instrumented gait analysis was furthermore used to correlate movement alterations to back pain [ 26 ], and to objectify treatment effects postoperatively [ 27 – 29 ] in LST patients.…”

Section: Introductionmentioning

confidence: 99%

Kinematic movement and balance parameter analysis in neurological gait disorders

Na,

Siebers,

Reim

et al. 2024

J Biol Eng

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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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Dynamic global sagittal alignment in patients with lumbar spinal stenosis: Analysis of the effects of decompression surgery on gait adaptations

Cited by 6 publications

References 32 publications

Effects Of Decompression Surgery On Pelvic Movements In Patients With Degenerative Lumbar Stenosis

Effects Of Decompression Surgery On Pelvic Movements In Patients With Degenerative Lumbar Stenosis

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

Kinematic movement and balance parameter analysis in neurological gait disorders

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