Muscle Function and Pelvic Stability While Walking in Patients With Symptomatic Lumbar Spinal Stenosis

Overview

This study is to quantify changes in muscle activity and pelvic stability during prolonged walking in patients with symptomatic lumbar spinal stenosis (sLSS) and healthy control subjects and to determine their association with the severity of the stenosis and the crosssectional area and fatty atrophy of lumbo-pelvic-hip muscles.

Full Title of Study: “WALK-LSS – Muscle Function and Pelvic Stability While Walking in Patients With Symptomatic Lumbar Spinal Stenosis”

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Cross-Sectional
  • Study Primary Completion Date: June 2021

Interventions

  • Other: Oswestry Disability Index (ODI) questionnaire
    • Participant’s level of low back pain and the extent to which the pain impacts his/ her daily life activities and social life are estimated with the standardized Oswestry Disability Index questionnaire
  • Diagnostic Test: self-paced walking test (SPWT)
    • walking back and forth at a self-selected pace along a hallway at the University Hospital until the onset of claudication, pain or until reaching the time limit of 30 minutes. Kinematic and electromyographic (EMG) data will be recorded every 3 minutes.

Arms, Groups and Cohorts

  • sLSS
    • patients diagnosed with sLSS scheduled for decompression surgery
  • control subjects
    • healthy, age-matched control subjects

Clinical Trial Outcome Measures

Primary Measures

  • Oswestry Disability Index (ODI) questionnaire
    • Time Frame: the day before decompression surgery
    • Participant’s level of low back pain and the extent to which the pain impacts his/ her daily life activities and social life; ten self-administered items compiling the ODI are: pain intensity, personal care, lifting, walking, sitting, standing, sleeping, sexual life, social life, travelling. The resulting scores are presented as scores from 0 (no impact) to 100 (bed bound and extremely limited). Higher values represent a worse outcome.
  • Muscle activation assessed by Electromyography (EMG)
    • Time Frame: scheduled the day before decompression surgery
    • Muscle activation of the multifidus, gluteus medius, erector spinae (longissimus), transversus abdominis muscles will be measured bilaterally using a 12- channel EMG system (myon AG, Schwarzenberg, Switzerland). Surface electrodes will be placed on these muscles (sampling rate = 2000 Hz). For each muscle, the frequency spectrum will be computed for each recording. Muscle fatigue will be defined as the slope of the mean frequency during the self-paced walking test (SPWT)
  • Pelvic stability
    • Time Frame: the day before decompression surgery
    • Pelvic stability will be assessed using an inertial sensor-based gait analysis system, more precisely by the sensor attached to the posterior superior iliac spine (RehaGait, Hasomed GmbH, Magdeburg, Germany). Pelvic stability will be measured in three planes (sagittal, transversal, frontal). Each sensor comprises a 3-axis accelerometer (± 16 g), a 3-axisgyroscope (± 2000 °/s) and a 3-axis compass (± 1.3 Gs). Dynamic stability will be defined as the root mean square ratio of the pelvic acceleration in each direction (anteroposterior, medio-lateral, vertical) normalized to walking Speed.
  • Cross-sectional area (CSA) of lumbo-pelvic-hip muscles
    • Time Frame: the day before decompression surgery
    • Quantitative measurements of the CSA will be obtained from an axial T1 vibe Dixon transversal sequence and will be assessed by using an imaging software (syngo.via, Siemens Healthineers, Erlangen, Germany). The Dixon method represents a commonly used method to suppress the signal of fat in magnetic resonance imaging (MRI). The range of interest (ROI) will be defined manually on L3/L4- and on L4/L5-level and will include the CSA of the musculus (m.) erector spinae and the m. psoas major bilaterally. The CSA will be set in relation to the subject’s Body mass. MRIs are routinely acquired in patients as diagnostics prior to surgery. The T1 vibe Dixon transversal sequence is not part of the standardized imaging protocol and will be added to the protocol for eligible patients for the purpose of this study.
  • Fatty atrophy of lumbo-pelvic-hip muscles
    • Time Frame: the day before decompression surgery
    • The fatty atrophy of the lumbo-pelvic-hip muscles will be assessed with an axial T2-weighted sequence enabling determining the fat fraction. The ROI will be defined manually on L3/L4- and on L4/L5-level and will include the erector spinae and the psoas major bilaterally. This sequence is part of the standardized imaging protocol.
  • walking capacity assessed by self-paced walking test distance (SPWT)
    • Time Frame: the day before decompression surgery
    • The SPWT will be conducted on a level surface in a hallway at the University Hospital. The duration, measured with a stopwatch by the administrator, and pain scores during walking, ranked between 0 and 10 and given every 5 minutes via oral feedback by the participant, will be assessed.
  • Grading of Severity of Lumbar Spinal Stenosis using the classification by Schizas
    • Time Frame: the day before decompression surgery
    • The stenosis grade will be assessed using the classification by Schizas.The 4-grade based classification is based on the morphology of the dural sac as observed on T2 axial MRI based on the rootlet/ cerebrospinal fluid ratio. Grade A stenosis: there is clearly cerebrospinal fluid (CSF) visible inside the dural sac, but its distribution is inhomogeneous. Grade B stenosis: the rootlets occupy the whole of the dural sac, but they can still be individualized. Some CSF is still present. Grade C stenosis: no rootlets can be recognized, the dural sac demonstrating a homogeneous gray signal with no CSF signal visible. There is epidural fat present posteriorly. Grade D stenosis: in addition to no rootlets being recognizable there is no epidural fat posteriorly. Grade A is defined as no or minor stenosis, B as moderate stenosis, C as severe stenosis, and D as extreme stenosis.

Participating in This Clinical Trial

Inclusion Criteria patients:

  • Diagnosed symptomatic lumbar spinal stenosis
  • Availability of lumbar MR images
  • Scheduled for decompressive surgery at the University Hospital Basel

Exclusion Criteria patients:

  • Prior decompressive surgery
  • Body Mass Index (BMI) ≥ 35 kg/m2
  • Additional pathologies that influence the mobility of the pelvis
  • Use of walking aids
  • Inability to provide informed consent

Exclusion Criteria healthy control subjects:

  • BMI ≥ 35 kg/m2
  • Pain in the lower extremity or lower back in the previous 6 months
  • Prior surgery of the lumbo-pelvic-hip complex
  • History of claudications
  • Neurological or orthopaedic conditions that may influence gait
  • Inability to provide informed consent

Gender Eligibility: All

Minimum Age: 30 Years

Maximum Age: 80 Years

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • University Hospital, Basel, Switzerland
  • Collaborator
    • Klinik für Radiologie und Nuklearmedizin, University Hospital Basel
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Annegret Muendermann, Prof. Dr. MD, Principal Investigator, Department of Orthopaedics and Traumatology, University Hospital Basel
  • Overall Contact(s)
    • Annegret Mündermann, Prof. Dr. MD, +41 61 328 5445, annegret.muendermann@usb.ch

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