Relationship Between L4/5 Lumbar Multifidus Cross-Sectional Area Ratio and Fall Risk in Older Adults with Lumbar Spinal Stenosis: A Retrospective Study.

Tadashi Ito,Yoshihito Sakai,Kazunori Yamazaki,Yoshifumi Morita,Makoto Oikawa

doi:10.3390/geriatrics4020038

Abstract

Various factors, including spinal deformities and trunk muscle atrophy, greatly affect the fall risk among older adults with lumbar spinal stenosis (LSS). However, the etiology of falls in older adults with degenerative LSS and trunk muscle atrophy is poorly understood. We investigated the association between trunk muscle atrophy and falls in older LSS patients. This retrospective study included 99 hospitalized older adults with LSS. Participants completed self-reported fall score questionnaires and were divided into the fall risk (n = 30) and non-fall risk (n = 69) groups. The patients’ low back pain visual analog scale score, Geriatric Depression Scale score, sagittal vertical axis, L4/5 lumbar multifidus cross-sectional area ratio (LMCSAR), and center of pressure (COP) values during quiet standing were evaluated. The fall risk group had a lower L4/5 LMCSAR (p = 0.002) and increased COP excursion (p = 0.034) than the non-fall risk group. No significant differences were observed in the other measured variables between the two groups. The L4/5 LMCSAR (p < 0.001) and COP (p = 0.024) were related to fall risk and may be useful in fall risk assessment in such populations. Strategies aimed at enhancing controlled lumbar segmental motion and improving trunk muscle stability or mass may decrease the fall risk in this cohort.

Highlights

Lumbar spinal stenosis is characterized by diminished available space for the neural and vascular elements in the lumbar spine [1]
The power analysis for the sample size revealed that the optimal sample size for this study was 62 participants
The effect sizes for the other variables were as follows: center of pressure (COP), d = 0.5; sagittal vertical axis (SVA), d = 0.2; age, d = 0.3; height, d = 0.3; weight, d = 0.1; BMI, d = 0.4; sex, Cramer’s V = 0.1; fall score, d = 3.2; visual analog scale (VAS), d = 0.3; and GDS, d = 0.3

Summary

Introduction

Lumbar spinal stenosis is characterized by diminished available space for the neural and vascular elements in the lumbar spine [1]. It results in the presentation of various symptoms, such as difficulties in standing in an upright position, muscle strength weakness, decreased mobility, and an increased fall risk [2]. Falls are a major risk for fractures in the growing geriatric population in developed countries; they are commonly observed among older adults and are associated with increased morbidity and disability [3]. Other studies have reported that the spine angle is associated with falls among community-dwelling older adults [12,13]

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Discussion

Conclusion