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Gait kinematics and spinal loading in patients with lumbar spinal stenosis and healthy older adults

BACKGROUND: Lumbar spinal stenosis (LSS) in older adults is a leading cause of pain and limitations to mobility. Compression of the spinal nerves can result in neurological symptoms that can decrease walking capacity and overall quality of life. It is clinically believed that patients with LSS alter their gait pattern to be able to increase their walking capacity but biomechanical assessment of spinal and pelvic motion during walking compared to healthy older adults is lacking. The purpose of this study was to gain further insight into how patients with LSS move and how their posture affects spinal loading compared to healthy older adults.
METHODS: Whole body motion data was collected on 9 patients with LSS and 10 healthy older adults. Both cohorts completed a 3D opto-electronic motion analysis during standing and walking trials and patients with LSS were measured during both asymptomatic and symptomatic states. Pelvis, knee, and spine kinematics and spinal loading were obtained via subject-specific musculoskeletal models.
RESULTS: In the LSS group, both asymptomatic and symptomatic trials, the average pelvic tilt was more posteriorly rotated than the healthy adults during standing and walking. Lumbar spine angles in the LSS group adopted a more flexed posture compared to the healthy group’s normal lordotic angle. This coincided with higher C7/S2 angles and distances compared to the healthy group. Lumbar spine loading doubled in both LSS groups compared to the healthy group’s standing trials, though little difference was seen during walking. Knee flexion angle increased greatly during both standing and walking.
CONCLUSIONS: My results indicate that LSS patients both stand and walk with greater posterior pelvic tilt and lumbar flexion which greater knee flexion to counterbalance compared to healthy counterparts. While the provocation of symptoms did not affect their kinematics, both asymptomatic and symptomatic states showed significant modification from older healthy adults. The clear differences in gait and posture can aid in therapeutic interventions but additional work is needed to better understand the biomechanical differences between these two groups.

Identiferoai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/46294
Date30 May 2023
CreatorsLynch, Andrew Charles
ContributorsAnderson, Dennis E., Allen, Dustin R.
Source SetsBoston University
Languageen_US
Detected LanguageEnglish
TypeThesis/Dissertation

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