Gait asymmetry of lower extremities reduced immediately after minimally invasive surgery among patients with lumbar disc herniation

Abstract

BackgroundLumbar disc herniation patients with increased pain exhibit greater gait asymmetry in stance time, swing time and single support time. Percutaneous endoscopic lumbar discectomy, as a minimally invasive surgical procedure has been used to treat patients with lumbar disc herniation. The objective of this study was to evaluate the immediate impact of the percutaneous endoscopic lumbar discectomy on gait asymmetry in spatiotemporal and kinetic parameters among lumbar disc herniation patients. MethodsMarker trajectories and ground reaction forces were measured during walking among 67 lumbar disc herniation patients and 15 healthy controls. Spatiotemporal gait parameters were analyzed via Visual3D. Muscle force and joint contact force were calculated with OpenSim. Gait asymmetry of those parameters were assessed with asymmetry index. FindingsAfter surgery, gait asymmetry in gait cycle time, step length, peak biceps femoris long head, tensor fasciae latae and rectus femoris muscle forces, and peak hip and knee joint contact forces reduced immediately. Postoperatively, increased gait cycle time and decreased step length were found in the affected side. Moreover, decreased peak biceps femoris long head, tensor fasciae latae and rectus femoris muscle forces, and peak hip joint contact force were observed in the contralateral side. InterpretationThese results suggested compensation strategy that biceps femoris long head, tensor fasciae latae and rectus femoris in the contralateral side were mainly used to compensate the affected side preoperatively in lumbar disc herniation patients, with less compensation between lower limbs after surgery, which may provide an insight into postoperative rehabilitation.