Altered postural timing and abnormally low use of proprioception in lumbar spinal stenosis pre- and post- surgical decompression.
Aged
Case-Control Studies
Exercise Therapy
Female
Healthy Volunteers
Humans
Laminectomy
Lumbar Vertebrae
/ surgery
Male
Middle Aged
Postoperative Period
Postural Balance
/ physiology
Posture
/ physiology
Preoperative Period
Reaction Time
/ physiology
Spinal Stenosis
/ physiopathology
Time Factors
Treatment Outcome
Center of pressure
Low back pain
Postural balance
Posturography
Quality of life
Walking speed
Journal
BMC musculoskeletal disorders
ISSN: 1471-2474
Titre abrégé: BMC Musculoskelet Disord
Pays: England
ID NLM: 100968565
Informations de publication
Date de publication:
01 May 2019
01 May 2019
Historique:
received:
23
10
2018
accepted:
06
03
2019
entrez:
3
5
2019
pubmed:
3
5
2019
medline:
3
9
2019
Statut:
epublish
Résumé
Lumbar spinal stenosis (LSS) is frequently associated with postural instability. Although several studies evaluated patients' functional impairments, underlying sensorimotor mechanisms are still poorly understood. We aimed to assess the specific set of postural control deficits associated with LSS during spontaneous and externally perturbed stance and evaluated post-surgical changes in postural behavior. We analyzed postural control in eleven LSS patients (age 69 ± 8 years) pre- and post-laminectomy, correlated experimental data with functional tests and patient-reported outcomes, and compared findings to 15 matched, healthy control subjects (age 70 ± 6 years). Postural control was characterized by spontaneous sway measures and measures of perturbed stance. Perturbations were induced by anterior-posterior pseudorandom tilts of the body support surface. We used an established postural control model to extract specific postural control parameters. Spontaneous sway amplitude, velocity and frequency were abnormally large in LSS patients. Furthermore, patients' postural reactions to platform tilts, represented by GAIN and PHASE were significantly altered. Based on simple feedback model simulations, we found that patients rely less on proprioceptive cues for stance regulation than healthy subjects. Moreover, their postural reactions' timing is altered. After surgery, patients' spontaneous sway amplitude was significantly reduced and their postural timing approximated the behavior of healthy subjects. The reduction in proprioceptive input for stance control due to stenosis-caused afferent dysfunction is a functional disadvantage for LSS patients - and may be the basis of increased spontaneous sway. This disadvantage may cause the timing of postural reactions to alter, with the intent of preventing rapid changes in stance regulation for safety reasons. After surgery, patients' postural timing approximated those of healthy subjects, while the abnormally low use of proprioception remained unchanged. We suggest the post-surgery rehabilitation of proprioception, eg through balance exercises on unstable surfaces and reduced visual input.
Sections du résumé
BACKGROUND
BACKGROUND
Lumbar spinal stenosis (LSS) is frequently associated with postural instability. Although several studies evaluated patients' functional impairments, underlying sensorimotor mechanisms are still poorly understood. We aimed to assess the specific set of postural control deficits associated with LSS during spontaneous and externally perturbed stance and evaluated post-surgical changes in postural behavior.
METHODS
METHODS
We analyzed postural control in eleven LSS patients (age 69 ± 8 years) pre- and post-laminectomy, correlated experimental data with functional tests and patient-reported outcomes, and compared findings to 15 matched, healthy control subjects (age 70 ± 6 years). Postural control was characterized by spontaneous sway measures and measures of perturbed stance. Perturbations were induced by anterior-posterior pseudorandom tilts of the body support surface. We used an established postural control model to extract specific postural control parameters.
RESULTS
RESULTS
Spontaneous sway amplitude, velocity and frequency were abnormally large in LSS patients. Furthermore, patients' postural reactions to platform tilts, represented by GAIN and PHASE were significantly altered. Based on simple feedback model simulations, we found that patients rely less on proprioceptive cues for stance regulation than healthy subjects. Moreover, their postural reactions' timing is altered. After surgery, patients' spontaneous sway amplitude was significantly reduced and their postural timing approximated the behavior of healthy subjects.
CONCLUSION
CONCLUSIONS
The reduction in proprioceptive input for stance control due to stenosis-caused afferent dysfunction is a functional disadvantage for LSS patients - and may be the basis of increased spontaneous sway. This disadvantage may cause the timing of postural reactions to alter, with the intent of preventing rapid changes in stance regulation for safety reasons. After surgery, patients' postural timing approximated those of healthy subjects, while the abnormally low use of proprioception remained unchanged. We suggest the post-surgery rehabilitation of proprioception, eg through balance exercises on unstable surfaces and reduced visual input.
Identifiants
pubmed: 31043162
doi: 10.1186/s12891-019-2497-0
pii: 10.1186/s12891-019-2497-0
pmc: PMC6495568
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
183Subventions
Organisme : FP7
ID : 610454
Organisme : H2020-SC1-2017-CNECT-1
ID : 769574
Organisme : DFG
ID : ADV139
Organisme : DFG
ID : ADV139
Organisme : DFG
ID : ADV139
Organisme : DFG
ID : ADV139
Références
Clin Biomech (Bristol, Avon). 1999 Dec;14(10):710-6
pubmed: 10545625
Biol Cybern. 2000 Apr;82(4):335-43
pubmed: 10804065
Arch Phys Med Rehabil. 2001 Feb;82(2):227-31
pubmed: 11239315
Phys Ther. 2001 Jul;81(7):1296-306
pubmed: 11444993
Spine (Phila Pa 1976). 2002 May 1;27(9):975-83
pubmed: 11979174
J Neurophysiol. 2002 Sep;88(3):1097-118
pubmed: 12205132
Clin Biomech (Bristol, Avon). 2002 Aug;17(7):548-50
pubmed: 12206948
Semin Neurol. 2002 Jun;22(2):157-66
pubmed: 12524561
Rehabilitation (Stuttg). 2003 Aug;42(4):218-25
pubmed: 12938044
Arch Phys Med Rehabil. 1992 Nov;73(11):1073-80
pubmed: 1444775
Spine (Phila Pa 1976). 2004 Mar 15;29(6):E107-12
pubmed: 15014284
Neurosci Lett. 2004 Mar 4;357(2):135-8
pubmed: 15036593
J Neurophysiol. 2005 Jan;93(1):189-200
pubmed: 15331614
J Am Geriatr Soc. 1992 Mar;40(3):203-7
pubmed: 1538035
J Orthop Sports Phys Ther. 2005 Apr;35(4):220-6
pubmed: 15901123
Exp Brain Res. 2006 May;171(2):231-50
pubmed: 16307252
Gait Posture. 2006 Nov;24(3):349-55
pubmed: 16311036
Exp Brain Res. 2007 Mar;177(3):411-8
pubmed: 16977448
J Electromyogr Kinesiol. 2009 Jun;19(3):380-90
pubmed: 18023594
N Engl J Med. 2008 Feb 21;358(8):818-25
pubmed: 18287604
Gait Posture. 2008 Nov;28(4):657-62
pubmed: 18541428
Eur Spine J. 2008 Sep;17(9):1177-84
pubmed: 18594876
Gait Posture. 2009 Apr;29(3):421-7
pubmed: 19084411
Exp Brain Res. 2009 Apr;194(3):419-33
pubmed: 19219426
Spine J. 2009 Jul;9(7):545-50
pubmed: 19398386
J Physiol Paris. 2009 Sep-Dec;103(3-5):149-58
pubmed: 19665564
J Geriatr Phys Ther. 2009;32(1):15-21
pubmed: 19856631
Eur Spine J. 2011 Mar;20(3):358-68
pubmed: 20721676
J Bodyw Mov Ther. 2010 Oct;14(4):361-6
pubmed: 20850043
J Comput Neurosci. 2011 Jun;30(3):759-78
pubmed: 21161357
Spine (Phila Pa 1976). 2011 Apr 20;36(9):E588-92
pubmed: 21242866
Eur Spine J. 2011 Dec;20(12):2152-9
pubmed: 21533851
Arthritis Care Res (Hoboken). 2011 Nov;63 Suppl 11:S350-70
pubmed: 22588756
Clin Biomech (Bristol, Avon). 2012 Nov;27(9):866-71
pubmed: 22748373
Cochrane Database Syst Rev. 2013 Aug 30;(8):CD010712
pubmed: 23996271
J Am Med Dir Assoc. 2014 Mar;15(3):227.e1-227.e6
pubmed: 24220138
J Phys Ther Sci. 2013 Jun;25(6):675-8
pubmed: 24259826
J Manipulative Physiol Ther. 2014 Nov-Dec;37(9):696-701
pubmed: 25267441
Neuromodulation. 2014 Oct;17 Suppl 2:3-10
pubmed: 25395111
Asian Spine J. 2015 Oct;9(5):818-28
pubmed: 26435805
Disabil Rehabil. 2018 Jan;40(2):232-237
pubmed: 27846739
J Neurophysiol. 1989 Oct;62(4):841-53
pubmed: 2809706
Front Aging Neurosci. 2017 Aug 11;9:273
pubmed: 28848430
BMC Musculoskelet Disord. 2018 Jun 15;19(1):192
pubmed: 29902972
Front Neurol. 2018 Jun 04;9:371
pubmed: 29915556
Spine (Phila Pa 1976). 1988 Nov;13(11):1303-7
pubmed: 3206291
J Neurophysiol. 1986 Jun;55(6):1369-81
pubmed: 3734861
Phys Ther. 1986 Oct;66(10):1548-50
pubmed: 3763708
J Am Geriatr Soc. 1986 Feb;34(2):119-26
pubmed: 3944402
Rehabilitation (Stuttg). 1996 Feb;35(1):I-VIII
pubmed: 8693180
IEEE Trans Biomed Eng. 1996 Sep;43(9):956-66
pubmed: 9214811
Arch Phys Med Rehabil. 1998 Jun;79(6):700-8
pubmed: 9630153