gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018)

23.10. - 26.10.2018, Berlin

Decompression surgery improves gait quality in patients with symptomatic lumbar spinal stenosis

Meeting Abstract

  • presenting/speaker Stefan Loske - Universitätsspital Basel, Basel , Switzerland
  • Corina Nüesch - Universitätsspital Basel, Basel , Switzerland
  • Kimberly Byrnes - Universitätsspital Basel, Basel , Switzerland
  • Oliver Fiebig - Universitätsspital Basel, Basel , Switzerland
  • Stefan Schären - Universitätsspital Basel, Basel , Switzerland
  • Cordula Netzer - Universitätsspital Basel, Basel , Switzerland
  • Annegret Mündermann - Universitätsspital Basel, Basel , Switzerland

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018). Berlin, 23.-26.10.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocST27-1019

doi: 10.3205/18dkou146, urn:nbn:de:0183-18dkou1464

Veröffentlicht: 6. November 2018

© 2018 Loske et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: To test the hypothesis that the Oswestry Disability Index (ODI) score, the walking distance (6MWD) during the six-minute walk test (6MWT) and gait quality (spatiotemporal parameters and gait asymmetry) will improve postoperatively and achieve normal values postoperatively; changes in gait parameters correlate with changes in ODI score; and patients' gait quality diminishes during the 6MWT reflected by changes in gait parameters during the 6MWT.

Methods: Patients with symptomatic lumbar spinal stenosis (LSS) were analyzed on the day before surgery and 10 weeks and 12 months postoperatively. Functional disability in daily life was assessed by the ODI. Spatiotemporal gait parameters were recorded with an inertial sensor system during a 6MWT, and the 6MWD was determined. Gait asymmetry was defined as 100*|right-left|/(0.5*(|right+left|)). Age-matched healthy control subjects were recruited from the community surrounding the clinic.

Study Design: Prospective observational study with intervention. EbM Level 2.

Results: The ODI decreased by 17.9% and 23.9% and 6MWD increased by 21 m and 26 m from baseline to 10-week and 12-month follow-up, respectively. Gait quality did not change during the 6MWT at any assessment or between assessments. Correlations between changes in ODI and changes in gait function were found (Figure 1). Compared to the control group, patients walked less during the 6MWT, and gait quality differed at baseline (spatio-temporal and asymmetry parameters) and 10-week follow-up (asymmetry parameters) but not at 12-month follow-up. Change in gait quality explained 39% and 73% of variance in change in ODI from baseline to 10-week and to 12-month follow-up, respectively.

Conclusions: The results of our study suggest that surgical treatment not only improves subjective outcome parameters such as functional limitations but also the patients' measurable gait quality and provide evidence for a clinically important improvement in gait function 10 weeks and 12 months after decompression surgery. Gait quality seems to be stable during a 6MWT in these patients. Changes in gait quality explained a large portion of variance in changes in the ODI indicating that patients with symptomatic LSS perceive their compromised gait quality as functional limitations. Gait data obtained with instrumented gait analysis contains information on gait quality that can be helpful for evaluating functional limitations in patients with LSS, the outcome of decompression surgery and the development of patient specific rehabilitation regimens.