Mousavi Seyed Javad, Lynch Andrew C, Allaire Brett T, White Andrew P, Anderson Dennis E
Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States.
Front Bioeng Biotechnol. 2021 Nov 18;9:751155. doi: 10.3389/fbioe.2021.751155. eCollection 2021.
Symptomatic lumbar spinal stenosis is a leading cause of pain and mobility limitation in older adults. It is clinically believed that patients with lumbar spinal stenosis adopt a flexed trunk posture or bend forward and alter their gait pattern to improve tolerance for walking. However, a biomechanical assessment of spine posture and motion during walking is broadly lacking in these patients. The purpose of this study was to evaluate lumbar spine and pelvic sagittal angles and lumbar spine compressive loads in standing and walking and to determine the effect of pain and neurogenic claudication symptoms in patients with symptomatic lumbar spinal stenosis. Seven participants with symptomatic lumbar spinal stenosis, aged 44-82, underwent a 3D opto-electronic motion analysis during standing and walking trials in asymptomatic and symptomatic states. Passive reflective marker clusters (four markers each) were attached to participants at T1, L1, and S2 levels of the spine, with additional reflective markers at other spinal levels, as well as the head, pelvis, and extremities. Whole-body motion data was collected during standing and walking trials in asymptomatic and symptomatic states. The results showed that the spine was slightly flexed during walking, but this was not affected by symptoms. Pelvic tilt was not different when symptoms were present, but suggests a possible effect of more forward tilt in both standing ( = 0.052) and walking ( = 0.075). Lumbar spine loading during symptomatic walking was increased by an average of 7% over asymptomatic walking ( = 0.001). Our results did not show increased spine flexion (adopting a trunk-flexed posture) and only indicate a trend for a small forward shift of the pelvis during both symptomatic walking and standing. This suggests that provocation of symptoms in these patients does not markedly affect their normal gait kinematics. The finding of increased spine loading with provocation of symptoms supports our hypothesis that spine loading plays a role in limiting walking function in patients with lumbar spinal stenosis, but additional work is needed to understand the biomechanical cause of this increase.
症状性腰椎管狭窄症是老年人疼痛和活动受限的主要原因。临床上认为，腰椎管狭窄症患者会采取躯干前屈姿势或向前弯腰，并改变其步态模式以提高行走耐受性。然而，这些患者在行走过程中对脊柱姿势和运动的生物力学评估普遍缺乏。本研究的目的是评估有症状的腰椎管狭窄症患者在站立和行走时的腰椎和骨盆矢状角以及腰椎压缩负荷，并确定疼痛和神经源性间歇性跛行症状的影响。7名年龄在44 - 82岁之间的症状性腰椎管狭窄症患者在无症状和有症状状态下的站立和行走试验中接受了三维光电运动分析。被动反射标记簇（每个4个标记）附着在参与者脊柱的T1、L1和S2水平，在其他脊柱水平以及头部、骨盆和四肢也有额外的反射标记。在无症状和有症状状态下的站立和行走试验中收集全身运动数据。结果表明，行走时脊柱略有前屈，但这不受症状影响。出现症状时骨盆倾斜度没有差异，但表明在站立（P = 0.052）和行走（P = 0.075）时可能有更多前倾的影响。有症状行走时的腰椎负荷比无症状行走时平均增加7%（P = 0.001）。我们的结果没有显示脊柱前屈增加（采取躯干前屈姿势），仅表明在有症状行走和站立时骨盆有小幅度向前移位的趋势。这表明这些患者症状的激发并没有明显影响其正常步态运动学。症状激发时脊柱负荷增加的发现支持了我们的假设，即脊柱负荷在限制腰椎管狭窄症患者行走功能中起作用，但需要更多工作来理解这种增加的生物力学原因。
