Abstract
Lumbar spinal stenosis (LSS) is a common disease in the elderly population; it has been reported that patients with LSS have an abnormal gait pattern due to symptom such as neurogenic intermittent claudication (NIC); however, no detailed reports exist on the plantar pressure distributions in LSS patients with NIC. To analysis the plantar pressure characteristics of LSS patients, the Footscan® pressure system was used to perform dynamic plantar pressure measurements in 20 LSS patients (age, 69.5 ± 7.2 years) before and after the occurrence of NIC. The contact time (CT), foot progression angle (FPA), pressure-time integral (PTI), and contact area (CA) were collected and compared between the LSS patients and age-matched healthy subjects in each measurement. The LSS group showed an increase in forefoot CT%, PTI, and CA% in both measurements compared with those in the control group. After the occurrence of NIC in the LSS group, CT%, PTI, and CA% of the forefoot increased further compared with those before the occurrence of NIC. In addition, after the occurrence of NIC, the PTI and CA% of the forefoot shifted from the medial foot to the lateral foot. The results suggested that the plantar pressure distributions of patients with LSS differs from normal subjects due to the posture of waking with lumbar forward flexion, and the forefoot bears a higher relative load. In addition, the occurrence of NIC could affect the plantar pressure distribution of the patients with LSS, predicting the patient's risk of falling to the anterior direction and to the symptomatic side.
Highlights
Lumbar spinal stenosis (LSS) refers to the nerve compression syndrome, in which the spinal canal narrows and compresses the dural sac, spinal cord, or nerve root [1]
The pathological process is mainly the degeneration and overgrowth of the bones, ligaments, and synovial tissue that constitute the lumbar spinal canal. This gradually leads to the compression of nerves and blood vessels in the spinal canal, or prolapse into the spinal canal due to disc degeneration resulting in a series of clinical symptoms [1, 2, 14]
In the gait analysis study of patients with LSS by Garbelotti et al [20], patients with LSS had shorter stride length, slower walking speed, and significantly longer stance phase compared with healthy subjects, which could be taken as the compensation strategy. The parameters, such as stride length and walking speed, were not directly measured in this study, the results showed that after the occurrence of neurogenic intermittent claudication (NIC), the total contact time (CT) in the LSS group was significantly longer than that in the control group, and no significant difference was found before the occurrence of NIC
Summary
Lumbar spinal stenosis (LSS) refers to the nerve compression syndrome, in which the spinal canal narrows and compresses the dural sac, spinal cord, or nerve root [1]. The prevalence of LSS increases with age; it is about 9.3% in the general population and up to 47% in individuals older than 60 years [2, 3]. For individuals older than 65 years, LSS can be the most common cause of lumbar surgery [4]. The incidence of LSS has increased because of the burden of aging population. The degree of LSS presented by imaging and the severity of clinical symptoms may have a relatively low correlation. Some individuals do have anatomical LSS, they may not have relevant clinical symptoms [7]. Besides imaging data, clinicians should consider the medical records and physical signs of the patients at the same time for the diagnosis of LSS [7, 8]
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