Gait behaviors as an objective surgical outcome in low back disorders: A systematic review.
BACKGROUND
Objective motor performance measures, especially gait assessment, could improve evaluation of low back disorder surgeries. However, no study has compared the relative effectiveness of gait parameters for assessing motor performance in low back disorders after surgery. The purpose of the current review was to determine the sensitive gait parameters that address physical improvements in each specific spinal disorder after surgical intervention.


METHODS
Articles were searched with the following inclusion criteria: 1) population studied consisted of individuals with low back disorders requiring surgery; 2) low back disorder was measured objectively using gait assessment tests pre- and post-surgery. The quality of the selected studies was assessed using Delphi consensus, and meta-analysis was performed to compare pre- and post-surgical changes.


RESULTS
Thirteen articles met inclusion criteria, which, almost exclusively, addressed two types of spinal disorders/interventions: 1) scoliosis/spinal fusion; and 2) stenosis/decompression. For patients with scoliosis, improvements in hip and shoulder motion (effect size=0.32-1.58), energy expenditure (effect size=0.59-1.18), and activity symmetry of upper-body muscles during gait were present after spinal fusion. For patients with spinal stenosis, increases in gait speed, stride length, cadence, symmetry, walking smoothness, and walking endurance (effect size=0.60-2.50), and decrease in gait variability (effect size=1.45) were observed after decompression surgery.


CONCLUSIONS
For patients with scoliosis, gait improvements can be better assessed by measuring upper-body motion and EMG rather than the lower extremities. For patients with spinal stenosis, motor performance improvements can be captured by measuring walking spatio-temporal parameters, gait patterns, and walking endurance.
interdisciplinary Consortium on Advanced Motion Performance (iCAMP) and Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, College of Medicine, University of Arizona, Tucson, USA.
Nima
N
Toosizadeh
Department of Physiology, College of Medicine, University of Arizona, Tucson, USA.
Tzu Chuan
TC
Yen
Arizona Health Sciences Library, University of Arizona, Tucson, USA.
Carol
C
Howe
Department of Orthopaedic Surgery, College of Medicine, University of Arizona, Tucson, USA.
Michael
M
Dohm
interdisciplinary Consortium on Advanced Motion Performance (iCAMP) and Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, College of Medicine, University of Arizona, Tucson, USA; Arizona Center on Aging, University of Arizona, Tucson, USA.
Jane
J
Mohler
interdisciplinary Consortium on Advanced Motion Performance (iCAMP) and Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, College of Medicine, University of Arizona, Tucson, USA; Arizona Center on Aging, University of Arizona, Tucson, USA. Electronic address: bnajafi@surgery.arizona.edu.
Bijan
B
Najafi
D019299:Decompression, Surgical; D004576:Electromyography; D005684:Gait / Q000502:physiology*; D006615:Hip / Q000502:physiology; D006801:Humans; D035002:Lower Extremity / Q000502:physiology; D009068:Movement; D012600:Scoliosis / Q000503:physiopathology* / Q000601:surgery*; D012782:Shoulder / Q000502:physiology; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology
Back pain; Evidence; Functional disorder; Operation; Outcome; Physical impairment