Characteristics of thoracic and lumbar movements during gait in lumbar spinal stenosis patients before and after decompression surgery.
BACKGROUND
Although gait analysis has been previously conducted for lumbar spinal stenosis patients, the vertebral segmental movements, such as of the thoracic and lumbar regions, and whether the spinal movement during gait changes after decompression surgery remain unclear.


METHODS
Ten patients with lumbar spinal stenosis and 10 healthy controls participated. Clinical outcomes were assessed using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and Visual Analogue Scale. Spinal kinematic data of the participants during gait were acquired using a three-dimensional motion analysis system. The trunk (whole spine), thoracic, and lumbar flexion and pelvic tilting values were calculated. Spinal kinematic data and clinical outcomes were collected preoperatively and 1month postoperatively for the patients.


RESULTS
Compared to that observed preoperatively, the clinical outcomes significantly improved at 1month postoperatively. In the standing position, the preoperative lumbar extension of the patients was significantly smaller than that of the controls. Moreover, during gait, the lumbar flexion relative to the standing position of the patients was smaller than that of the controls preoperatively, and increased at 1month postoperatively. The sum of the thoracic and lumbar flexion values during gait negatively correlated with the score for leg pain.


CONCLUSIONS
The epidural pressure of lumbar spinal stenosis patients is known to be higher than that of normal subjects during gait, and to decrease during walking with lumbar flexion. Preoperatively, smaller thoracic and lumbar flexion movements during gait relative to the standing position cannot decrease epidural pressure; as a result, severe leg pain might be induced.
Health Sciences Major, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
Wataru
W
Kuwahara
Department of Orthopaedic Surgery, Aichi Medical University, Aichi, Japan. Electronic address: snm3@aichi-med-u.ac.jp.
Masataka
M
Deie
Department of Musculoskeletal Functional Research and Regeneration, Hiroshima University, Hiroshima, Japan.
Naoto
N
Fujita
Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan.
Nobuhiro
N
Tanaka
Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan.
Kazuyoshi
K
Nakanishi
Department of Analysis and Control of Upper Extremity Function, Hiroshima University, Hiroshima, Japan.
Toru
T
Sunagawa
Health Sciences Major, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
Makoto
M
Asaeda
Health Sciences Major, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
Haruka
H
Nakamura
Department of Rehabilitation, Hiroshima University Hospital, Hiroshima, Japan.
Yoshifumi
Y
Kono
Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan.
Mitsuo
M
Ochi
D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D010147:Pain Measurement; D011187:Posture / Q000502:physiology; D016059:Range of Motion, Articular; D013130:Spinal Stenosis / Q000503:physiopathology* / Q000601:surgery; D013904:Thoracic Vertebrae / Q000503:physiopathology*; D016138:Walking
Decompression surgery; Gait analysis; Leg pain; Low back pain; Lumbar spinal stenosis; Vertebral segmental movement