European Spine Journal

, Volume 19, Issue 11, pp 1855–1864 | Cite as

Step activity monitoring in lumbar stenosis patients undergoing decompressive surgery

  • Tobias L. Schulte
  • Tim Schubert
  • Corinna Winter
  • Mirko Brandes
  • Lars Hackenberg
  • Hansdetlef Wassmann
  • Dennis Liem
  • Dieter Rosenbaum
  • Viola Bullmann
Original Article

Abstract

Symptomatic degenerative central lumbar spinal stenosis (LSS) is a frequent indication for decompressive spinal surgery, to reduce spinal claudication. No data are as yet available on the effect of surgery on the level of activity measured with objective long-term monitoring. The aim of this prospective, controlled study was to objectively quantify the level of activity in central LSS patients before and after surgery, using a continuous measurement device. The objective data were correlated with subjective clinical results and the radiographic degree of stenosis. Forty-seven patients with central LSS and typical spinal claudication scheduled for surgery were included. The level of activity (number of gait cycles) was quantified for 7 consecutive days using the StepWatch Activity Monitor (SAM). Visual analogue scales (VAS) for back and leg pain, Oswestry disability index and Roland–Morris score were used to assess the patients’ clinical status. The patients were investigated before surgery and 3 and 12 months after surgery. In addition, the radiographic extent of central LSS was measured digitally on preoperative magnetic resonance imaging or computed tomography. The following results were found preoperatively: 3,578 gait cycles/day, VAS for back pain 5.7 and for leg pain 6.5. Three months after surgery, the patients showed improvement: 4,145 gait cycles/day, VAS for back pain 4.0 and for leg pain 3.0. Twelve months after surgery, the improvement continued: 4,335 gait cycles/day, VAS for back pain 4.1 and for leg pain 3.3. The clinical results and SAM results showed significant improvement when preoperative data were compared with data 3 and 12 months after surgery. The results 12 months after surgery did not differ significantly from those 3 months after surgery. The level of activity correlated significantly with the degree of leg pain. The mean cross-sectional area of the spinal canal at the central LSS was 94 mm2. The radiographic results did not correlate either with objective SAM results or with clinical outcome parameters. In conclusion, this study is the first to present objective data on continuous activity monitoring/measurements in patients with central LSS. The SAM could be an adequate tool for performing these measurements in spine patients. Except for leg pain, the objective SAM results did not correlate with the clinical results or with the radiographic extent of central LSS.

Keywords

Step activity monitor (SAM) Lumbar spinal stenosis Decompression Level of activity Mobility 

References

  1. 1.
    Anjarwalla NK, Brown LC, McGregor AH (2007) The outcome of spinal decompression surgery 5 years on. Eur Spine J 16:1842–1847CrossRefPubMedGoogle Scholar
  2. 2.
    Athiviraham A, Yen D, Scott C, Soboleski D (2007) Clinical correlation of radiological spinal stenosis after standardization for vertebral body size. Clin Radiol 62:776–780CrossRefPubMedGoogle Scholar
  3. 3.
    Barz T, Melloh M, Staub L, Roeder C, Lange J, Smiszek FG, Theis JC, Merk HR (2008) The diagnostic value of a treadmill test in predicting lumbar spinal stenosis. Eur Spine J 17:686–690CrossRefPubMedGoogle Scholar
  4. 4.
    Bergman RJ, Bassett DR Jr, Muthukrishnan S, Klein DA (2008) Validity of 2 devices for measuring steps taken by older adults in assisted-living facilities. J Phys Act Health 5(Supp 1):S166–S175PubMedGoogle Scholar
  5. 5.
    Bjornson KF, Belza B, Kartin D, Logsdon R, McLaughlin JF (2007) Ambulatory physical activity performance in youth with cerebral palsy and youth who are developing typically. Phys Ther 87:248–257 (discussion 57–60)CrossRefPubMedGoogle Scholar
  6. 6.
    Bowden MG, Behrman AL (2007) Step activity monitor: accuracy and test-retest reliability in persons with incomplete spinal cord injury. J Rehabil Res Dev 44:355–362CrossRefPubMedGoogle Scholar
  7. 7.
    Brandes M, Rosenbaum D (2004) Correlations between the step activity monitor and the DynaPort ADL-monitor. Clin Biomech (Bristol, Avon) 19:91–94CrossRefGoogle Scholar
  8. 8.
    Braybrooke J, Ahn H, Gallant A, Ford M, Bronstein Y, Finkelstein J, Yee A (2007) The impact of surgical wait time on patient-based outcomes in posterior lumbar spinal surgery. Eur Spine J 16:1832–1839CrossRefPubMedGoogle Scholar
  9. 9.
    Cavanaugh JT, Coleman KL, Gaines JM, Laing L, Morey MC (2007) Using step activity monitoring to characterize ambulatory activity in community-dwelling older adults. J Am Geriatr Soc 55:120–124CrossRefPubMedGoogle Scholar
  10. 10.
    Clemes SA, Griffiths PL (2008) How many days of pedometer monitoring predict monthly ambulatory activity in adults? Med Sci Sports Exerc 40:1589–1595CrossRefPubMedGoogle Scholar
  11. 11.
    Daffner SD, Wang JC (2009) The pathophysiology and nonsurgical treatment of lumbar spinal stenosis. Instr Course Lect 58:657–668PubMedGoogle Scholar
  12. 12.
    De Bruin ED, Najafi B, Murer K, Uebelhart D, Aminian K (2007) Quantification of everyday motor function in a geriatric population. J Rehabil Res Dev 44:417–428CrossRefPubMedGoogle Scholar
  13. 13.
    Deen HG, Zimmerman RS, Lyons MK, McPhee MC, Verheijde JL, Lemens SM (1998) Use of the exercise treadmill to measure baseline functional status and surgical outcome in patients with severe lumbar spinal stenosis. Spine 23:244–248CrossRefPubMedGoogle Scholar
  14. 14.
    Geisser ME, Haig AJ, Tong HC, Yamakawa KS, Quint DJ, Hoff JT, Miner JA, Phalke VV (2007) Spinal canal size and clinical symptoms among persons diagnosed with lumbar spinal stenosis. Clin J Pain 23:780–785CrossRefPubMedGoogle Scholar
  15. 15.
    Gelalis ID, Stafilas KS, Korompilias AV, Zacharis KC, Beris AE, Xenakis TA (2006) Decompressive surgery for degenerative lumbar spinal stenosis: long-term results. Int Orthop 30:59–63CrossRefPubMedGoogle Scholar
  16. 16.
    Malghem J, Willems X, Vande Berg B, Robert A, Cosnard G, Lecouvet F (2009) Comparison of lumbar spinal canal measurements on MRI and CT. J Radiol 90:493–497CrossRefPubMedGoogle Scholar
  17. 17.
    Mannion AF, Junge A, Fairbank JC, Dvorak J, Grob D (2006) Development of a German version of the Oswestry disability index. Part 1: cross-cultural adaptation, reliability, and validity. Eur Spine J 15:55–65CrossRefPubMedGoogle Scholar
  18. 18.
    Mannion AF, Junge A, Grob D, Dvorak J, Fairbank JC (2006) Development of a German version of the Oswestry disability index. Part 2: sensitivity to change after spinal surgery. Eur Spine J 15:66–73CrossRefPubMedGoogle Scholar
  19. 19.
    McDonald CM, Widman L, Abresch RT, Walsh SA, Walsh DD (2005) Utility of a step activity monitor for the measurement of daily ambulatory activity in children. Arch Phys Med Rehabil 86:793–801CrossRefPubMedGoogle Scholar
  20. 20.
    Mudge S, Stott NS, Walt SE (2007) Criterion validity of the StepWatch Activity Monitor as a measure of walking activity in patients after stroke. Arch Phys Med Rehabil 88:1710–1715CrossRefPubMedGoogle Scholar
  21. 21.
    Murphy DR, Hurwitz EL, Gregory AA, Clary R (2006) A non-surgical approach to the management of lumbar spinal stenosis: a prospective observational cohort study. BMC Musculoskelet Disord 7:16CrossRefPubMedGoogle Scholar
  22. 22.
    Rydevik B, Brown MD, Lundborg G (1984) Pathoanatomy and pathophysiology of nerve root compression. Spine (Phila Pa 1976) 9:7–15Google Scholar
  23. 23.
    Rydevik BL (1992) The effects of compression on the physiology of nerve roots. J Manipulative Physiol Ther 15:62–66PubMedGoogle Scholar
  24. 24.
    Schonstrom NS, Bolender NF, Spengler DM (1985) The pathomorphology of spinal stenosis as seen on CT scans of the lumbar spine. Spine (Phila Pa 1976) 10:806–811Google Scholar
  25. 25.
    Schulte TL, Bullmann V, Lerner T, Schneider M, Marquardt B, Liljenqvist U, Pietila TA, Hackenberg L (2006) [Lumbar spinal stenosis]. Orthopäde 35:675–692 (quiz 93–94)CrossRefPubMedGoogle Scholar
  26. 26.
    Schulte TL, Heidenreich JO, Schilling AM, Stendel R, Pietila TA, Hopfenmuller W, Brock M, Wolf KJ (2004) Comparison of metric analysis of spinal structures, exemplarily of the ligamentum flavum, obtained with CT and MRI. Eur J Radiol 52:224–228CrossRefPubMedGoogle Scholar
  27. 27.
    Stepien JM, Cavenett S, Taylor L, Crotty M (2007) Activity levels among lower-limb amputees: self-report versus step activity monitor. Arch Phys Med Rehabil 88:896–900CrossRefPubMedGoogle Scholar
  28. 28.
    Suda Y, Saitou M, Shibasaki K, Yamazaki N, Chiba K, Toyama Y (2002) Gait analysis of patients with neurogenic intermittent claudication. Spine 27:2509–2513CrossRefPubMedGoogle Scholar
  29. 29.
    Szpalski M, Gunzburg R (2003) Lumbar spinal stenosis in the elderly: an overview. Eur Spine J 12(Suppl 2):S170–S175CrossRefPubMedGoogle Scholar
  30. 30.
    Tudor-Locke C, Burkett L, Reis JP, Ainsworth BE, Macera CA, Wilson DK (2005) How many days of pedometer monitoring predict weekly physical activity in adults? Prev Med 40:293–298CrossRefPubMedGoogle Scholar
  31. 31.
    Tudor-Locke CE, Myers AM (2001) Challenges and opportunities for measuring physical activity in sedentary adults. Sports Med 31:91–100CrossRefPubMedGoogle Scholar
  32. 32.
    Vanhees L, Lefevre J, Philippaerts R, Martens M, Huygens W, Troosters T, Beunen G (2005) How to assess physical activity? How to assess physical fitness? Eur J Cardiovasc Prev Rehabil 12:102–114CrossRefPubMedGoogle Scholar
  33. 33.
    Verbiest H (1957) A radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg Br 36:230–237Google Scholar
  34. 34.
    Watters WC 3rd, Baisden J, Gilbert TJ, Kreiner S, Resnick DK, Bono CM, Ghiselli G, Heggeness MH, Mazanec DJ, O’Neill C, Reitman CA, Shaffer WO, Summers JT, Toton JF (2008) Degenerative lumbar spinal stenosis: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis. Spine J 8:305–310CrossRefPubMedGoogle Scholar
  35. 35.
    Whitehurst M, Brown LE, Eidelson SG, D’Angelo A (2001) Functional mobility performance in an elderly population with lumbar spinal stenosis. Arch Phys Med Rehabil 82:464–467CrossRefPubMedGoogle Scholar
  36. 36.
    Wiesinger GF, Nuhr M, Quittan M, Ebenbichler G, Wolfl G, Fialka-Moser V (1999) Cross-cultural adaptation of the Roland–Morris questionnaire for German-speaking patients with low back pain. Spine 24:1099–1103CrossRefPubMedGoogle Scholar
  37. 37.
    Wildermuth S, Zanetti M, Duewell S, Schmid MR, Romanowski B, Benini A, Boni T, Hodler J (1998) Lumbar spine: quantitative and qualitative assessment of positional (upright flexion and extension) MR imaging and myelography. Radiology 207:391–398PubMedGoogle Scholar
  38. 38.
    Winter C, Muller C, Brandes M, Brinkmann A, Hoffmann C, Hardes J, Gosheger G, Boos J, Rosenbaum D (2009) Level of activity in children undergoing cancer treatment. Pediatr Blood Cancer 53:438–443CrossRefPubMedGoogle Scholar
  39. 39.
    Yukawa Y, Lenke LG, Tenhula J, Bridwell KH, Riew KD, Blanke K (2002) A comprehensive study of patients with surgically treated lumbar spinal stenosis with neurogenic claudication. J Bone Joint Surg Am 84-A:1954–1959PubMedGoogle Scholar
  40. 40.
    Zeifang F, Schiltenwolf M, Abel R, Moradi B (2008) Gait analysis does not correlate with clinical and MR imaging parameters in patients with symptomatic lumbar spinal stenosis. BMC Musculoskelet Disord 9:89CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Tobias L. Schulte
    • 1
  • Tim Schubert
    • 1
  • Corinna Winter
    • 2
  • Mirko Brandes
    • 2
  • Lars Hackenberg
    • 1
  • Hansdetlef Wassmann
    • 3
  • Dennis Liem
    • 1
  • Dieter Rosenbaum
    • 2
  • Viola Bullmann
    • 1
  1. 1.Department of OrthopaedicsMünster University HospitalMünsterGermany
  2. 2.Motion Analysis LaboratoryMünster University HospitalMünsterGermany
  3. 3.Department of NeurosurgeryMünster University HospitalMünsterGermany

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