Gait behaviors as an objective surgical outcome in low back disorders: A systematic review

Abstract

Background: Objective motor performance measures, especially gait assessment, could improve evaluation of low back disorder surgeries. However, no study has compared the relative effectiveness of gait parameters for assessing motor performance in low back disorders after surgery. The purpose of the current review was to determine the sensitive gait parameters that address physical improvements in each specific spinal disorder after surgical intervention.

Methods: Articles were searched with the following inclusion criteria: 1) population studied consisted of individuals with low back disorders requiring surgery; 2) low back disorder was measured objectively using gait assessment tests pre- and post-surgery. The quality of the selected studies was assessed using Delphi consensus, and meta-analysis was performed to compare pre- and post-surgical changes.

Findings: Thirteen articles met inclusion criteria, which, almost exclusively, addressed two types of spinal disorders/interventions: 1) scoliosis/spinal fusion; and 2) stenosis/decompression. For patients with scoliosis, improvements in hip and shoulder motion (effect size=0.32-1.58), energy expenditure (effect size=0.59-1.18), and activity symmetry of upper-body muscles during gait were present after spinal fusion. For patients with spinal stenosis, increases in gait speed, stride length, cadence, symmetry, walking smoothness, and walking endurance (effect size=0.60-2.50), and decrease in gait variability (effect size=1.45) were observed after decompression surgery.

Interpretation: For patients with scoliosis, gait improvements can be better assessed by measuring upper-body motion and EMG rather than the lower extremities. For patients with spinal stenosis, motor performance improvements can be captured by measuring walking spatio-temporal parameters, gait patterns, and walking endurance.

Keywords: Back pain; Evidence; Functional disorder; Operation; Outcome; Physical impairment.

Conflict of interest statement

Conflict of interest

There is no conflict of interest for the current study.

Copyright © 2015 Elsevier Ltd. All rights reserved.

Figures

Figure 1

Flowchart of the process of literature search and extraction of studies meeting the inclusion criteria

Figure 2

Forest plot for alterations of gait parameters (a: gait speed, b: cadence, and c: stride length) in scoliosis patients one year following fusion surgery. The dotted vertical line corresponds to the summary effect size of the sample. The solid vertical line correspondents to an effect size of 0 (no effect). d: effect size CI: confidence interval

Figure 3

Forest plot for alterations of gait parameters (a: gait speed, b: cadence, and c: stride length) in scoliosis patients two years following fusion surgery. The dotted vertical line corresponds to the summary effect size of the sample. The solid vertical line correspondents to an effect size of 0 (no effect). d: effect size CI: confidence interval