Schulte Tobias L, Schubert Tim, Winter Corinna, Brandes Mirko, Hackenberg Lars, Wassmann Hansdetlef, Liem Dennis, Rosenbaum Dieter, Bullmann Viola
Department of Orthopaedics, Münster University Hospital, Albert-Schweitzer-Strasse 33, 48149, Münster, Germany.
Eur Spine J. 2010 Nov;19(11):1855-64. doi: 10.1007/s00586-010-1324-y. Epub 2010 Feb 26.
Symptomatic degenerative central lumbar spinal stenosis (LSS) is a frequent indication for decompressive spinal surgery, to reduce spinal claudication. No data are as yet available on the effect of surgery on the level of activity measured with objective long-term monitoring. The aim of this prospective, controlled study was to objectively quantify the level of activity in central LSS patients before and after surgery, using a continuous measurement device. The objective data were correlated with subjective clinical results and the radiographic degree of stenosis. Forty-seven patients with central LSS and typical spinal claudication scheduled for surgery were included. The level of activity (number of gait cycles) was quantified for 7 consecutive days using the StepWatch Activity Monitor (SAM). Visual analogue scales (VAS) for back and leg pain, Oswestry disability index and Roland-Morris score were used to assess the patients' clinical status. The patients were investigated before surgery and 3 and 12 months after surgery. In addition, the radiographic extent of central LSS was measured digitally on preoperative magnetic resonance imaging or computed tomography. The following results were found preoperatively: 3,578 gait cycles/day, VAS for back pain 5.7 and for leg pain 6.5. Three months after surgery, the patients showed improvement: 4,145 gait cycles/day, VAS for back pain 4.0 and for leg pain 3.0. Twelve months after surgery, the improvement continued: 4,335 gait cycles/day, VAS for back pain 4.1 and for leg pain 3.3. The clinical results and SAM results showed significant improvement when preoperative data were compared with data 3 and 12 months after surgery. The results 12 months after surgery did not differ significantly from those 3 months after surgery. The level of activity correlated significantly with the degree of leg pain. The mean cross-sectional area of the spinal canal at the central LSS was 94 mm(2). The radiographic results did not correlate either with objective SAM results or with clinical outcome parameters. In conclusion, this study is the first to present objective data on continuous activity monitoring/measurements in patients with central LSS. The SAM could be an adequate tool for performing these measurements in spine patients. Except for leg pain, the objective SAM results did not correlate with the clinical results or with the radiographic extent of central LSS.
症状性退行性中央型腰椎管狭窄症（LSS）是减压性脊柱手术的常见适应证，目的是减轻脊髓间歇性跛行。目前尚无关于手术对通过客观长期监测所测量的活动水平影响的数据。这项前瞻性对照研究的目的是使用连续测量设备客观量化中央型LSS患者手术前后的活动水平。客观数据与主观临床结果及狭窄的影像学程度相关。纳入了47例计划接受手术的中央型LSS且有典型脊髓间歇性跛行的患者。使用步数监测活动仪（SAM）连续7天量化活动水平（步态周期数）。使用背部和腿部疼痛的视觉模拟量表（VAS）、Oswestry功能障碍指数和罗兰-莫里斯评分来评估患者的临床状况。在手术前以及术后3个月和12个月对患者进行调查。此外，在术前磁共振成像或计算机断层扫描上数字测量中央型LSS的影像学范围。术前结果如下：每天3578个步态周期，背部疼痛VAS为5.7，腿部疼痛VAS为6.5。术后3个月，患者情况改善：每天4145个步态周期，背部疼痛VAS为4.0，腿部疼痛VAS为3.0。术后12个月，改善持续：每天4335个步态周期，背部疼痛VAS为4.1，腿部疼痛VAS为3.3。将术前数据与术后3个月和12个月的数据进行比较时，临床结果和SAM结果显示有显著改善。术后12个月的结果与术后3个月的结果无显著差异。活动水平与腿部疼痛程度显著相关。中央型LSS处椎管的平均横截面积为94平方毫米。影像学结果与客观的SAM结果或临床结局参数均无相关性。总之, 本研究首次呈现了中央型LSS患者连续活动监测/测量的客观数据。SAM可能是对脊柱患者进行这些测量的合适工具。除腿部疼痛外，客观的SAM结果与临床结果或中央型LSS的影像学范围均无相关性。
