Dynamic global sagittal alignment in patients with lumbar spinal stenosis: Analysis of the effects of decompression surgery on gait adaptations |
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| Affiliation: | 1. Dijon University Hospital, Department of Orthopaedic Surgery, Dijon, France;2. INSERM, CIC 1432, Module Plurithematique, Plateforme d’Investigation Technologique, Dijon, France;3. INSERM, CIC 1432, Clinical Epidemiology Unit, Dijon, France;4. Dijon University Hospital, Department of Neurosurgery, Dijon, France;5. Dijon University Hospital, Department of Rheumatology, Dijon, France;6. INSERM, U1093, CAPS, Dijon, France;1. Department of Orthopaedics, NYU Langone Orthopedic Hospital, 301 East 17th St, New York, NY 10003, USA;2. Department of Orthopaedics, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA;1. Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Spinal Movement Biomechanics Group, Bern, Switzerland;2. Bern University Hospital, Inselspital, Department of Physiotherapy, Bern, Switzerland;3. Balgrist University Hospital, Department of Chiropractic Medicine, Integrative Spinal Research, Zurich, Switzerland;2. Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan;3. Department of Orthopaedic Surgery, School of Medicine, Gifu University, Gifu, Japan;4. Department of Orthopaedics Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan;6. Department of Orthopaedic Surgery, Osaka Red Cross Hospital, Osaka, Japan;1. Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan;2. Division of Regenerative Medicine for Musculoskeletal System, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan;3. Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan;4. Center for Cybernics Research, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan |
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| Abstract: | ![]()
BackgroundLumbar spinal stenosis (LSS) leads patients to adapt their posture and walking parameters. Pelvic retroversion might be a compensation mechanism of pain. Pelvic and lower limbs compensations during gait are still not precisely understood, as well as the effect of a surgical decompression on them. These dynamic parameters can be studied through three-dimensional gait analysis.Research questionIs the dynamic pelvic tilt modified after decompression surgery in LSS patients compared to asymptomatic subjects?Material and methods50 asymptomatic subjects (C-group) and 37 patients operated on for lumbar decompression underwent a three-dimensional gait analysis one month before (M0) and six months after (M6) the surgery. 3D gait analysis was performed and hip and knee flexion, trunk kinematics, walking speed, stride length and pelvic tilt during gait or dynamic pelvic tilt (dPT) were recorded. Health-related quality of life (HRQL) scores (Oswestry Disability Index (ODI) and Visual Analogic Scales (VAS)) and radiological assessment were performed preoperatively and postoperatively.ResultsMean values of maximum and minimum dPT in the LSS-group preoperatively were significantly higher compared to the C-group (respectively 10.9 (6.2)° versus 7.3 (5.6)°, p = 0.003; 7.7 (6.1)° versus 4.8 (5.8)°, p = 0.011), and were significantly lowered at M6 (respectively 10.9 (6.2)° versus 8.1 (4.8)°, p = 0.0087; and 7.7 (6.1)° versus 5.1 (4.7)°, p = 0.012), and became similar to the C-group. The dPT range of motion at M0 and M6 were similar, and were both significantly higher than control values. Mean values of maximum and minimum hip flexion were significantly higher at M0 compared to the C-group, and were significantly lowered at M6. No difference was found between the pre- and postoperative radiographic pelvic tilt. The VAS for lumbar pain, the VAS for radicular pain and the ODI were significantly decreased at M6.SignificanceCompared to asymptomatic people, LSS patients walked with a pelvic anteversion, a hip flessum and a knee flessum before surgery, which tended to disappear after the surgical decompression. These differences were not noticed on static radiographs. |
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| Keywords: | Dynamic pelvic tilt Gait analysis Lumbar spinal stenosis Global sagittal alignment |
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