Abstract
BackgroundLumbar 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.MethodsWe 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.ResultsSpontaneous 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.ConclusionThe 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.
Highlights
Lumbar spinal stenosis (LSS) is frequently associated with postural instability
The lumbar spinal stenosis in our patients was due to an acquired degeneration and consecutive narrowing of the central canal leading to neurogenic claudication
Healthy subjects integrated more proprioceptive information for stance regulation resulting in a greater GAIN. These findings are emphasized by our model-based approach, where we found patients’ proprioceptive cues (Wp) down-weighted and as a result, space cues implicitly up-weighted when compared to healthy subjects
Summary
Lumbar spinal stenosis (LSS) is frequently associated with postural instability. several studies evaluated patients’ functional impairments, underlying sensorimotor mechanisms are still poorly understood. Degenerative lumbar spinal stenosis (LSS), which is commonly diagnosed between the 6th and 7th decade [1, 2], is often accompanied by functional impairments like gait and balance problems [3,4,5,6,7,8,9]. It is a frequent cause for spinal claudication and can lead to chronic or recurrent low back pain (LBP) syndrome [1, 2], which, in turn, is increasingly prevalent in industrial nations [10]. There is little knowledge about postural control behavior in the various subgroups of LBP patients
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