Altered postural timing and abnormally low use of proprioception in lumbar spinal stenosis pre- and post- surgical decompression

Sarah Kneis, Verena Bruetsch, Daniela Dalin, Ulrich Hubbe, Christoph Maurer, Sarah Kneis, Verena Bruetsch, Daniela Dalin, Ulrich Hubbe, Christoph Maurer

Abstract

Background: Lumbar spinal stenosis (LSS) is frequently associated with postural instability. Although several studies evaluated patients' functional impairments, underlying sensorimotor mechanisms are still poorly understood. We aimed to assess the specific set of postural control deficits associated with LSS during spontaneous and externally perturbed stance and evaluated post-surgical changes in postural behavior.

Methods: We analyzed postural control in eleven LSS patients (age 69 ± 8 years) pre- and post-laminectomy, correlated experimental data with functional tests and patient-reported outcomes, and compared findings to 15 matched, healthy control subjects (age 70 ± 6 years). Postural control was characterized by spontaneous sway measures and measures of perturbed stance. Perturbations were induced by anterior-posterior pseudorandom tilts of the body support surface. We used an established postural control model to extract specific postural control parameters.

Results: Spontaneous sway amplitude, velocity and frequency were abnormally large in LSS patients. Furthermore, patients' postural reactions to platform tilts, represented by GAIN and PHASE were significantly altered. Based on simple feedback model simulations, we found that patients rely less on proprioceptive cues for stance regulation than healthy subjects. Moreover, their postural reactions' timing is altered. After surgery, patients' spontaneous sway amplitude was significantly reduced and their postural timing approximated the behavior of healthy subjects.

Conclusion: The reduction in proprioceptive input for stance control due to stenosis-caused afferent dysfunction is a functional disadvantage for LSS patients - and may be the basis of increased spontaneous sway. This disadvantage may cause the timing of postural reactions to alter, with the intent of preventing rapid changes in stance regulation for safety reasons. After surgery, patients' postural timing approximated those of healthy subjects, while the abnormally low use of proprioception remained unchanged. We suggest the post-surgery rehabilitation of proprioception, eg through balance exercises on unstable surfaces and reduced visual input.

Keywords: Center of pressure; Low back pain; Postural balance; Posturography; Quality of life; Walking speed.

Conflict of interest statement

Ethics approval and consent to participate

Ethics approval was granted by the Ethics Committee of the University of Freiburg (256/01). Each patient had to sign written informed consent prior to inclusion.

Consent for publication

Not applicable.

Competing interests

The authors have no competing interests to declare.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Spontaneous sway. Center of pressure (COP) parameters: mean and standard error of (a) root mean square (RMS), (b) mean velocity (MV) and (c) center frequency (CF) of COP sway in (i) anterior-posterior and (ii) medio-lateral direction each for eyes open (eo) and eyes closed (ec) condition in healthy control subjects, patients before (pre) and after (post) surgery. Significant differences between healthy control subjects and patients before (pre) surgery are indicated with an asterisk
Fig. 2
Fig. 2
Transfer functions. Mean and standard error of GAIN (AI – CI) and PHASE (AII – CII) behavior as a function of frequency for eyes-open (eo) and eyes-closed (ec) condition (A), for 0.5° and 1° rotational amplitude (B) and body segments (C) in healthy control subjects, patients before (pre) and after (post) surgery. Significant differences between healthy control subjects and patients before (pre) surgery are indicated with an asterisk
Fig. 3
Fig. 3
Model parameters. Mean and standard error of the proprioceptive sensory weight (Wp) for 0.5° and 1° rotational amplitude in healthy control subjects, patients before (pre) and after (post) surgery. Significant differences between healthy control subjects and patients before (pre) surgery are indicated with an asterisk

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