RESUMEN
BACKGROUND: Self-report measures are used to evaluate surgery outcome but are not necessarily indicative of actual disabilities. RESEARCH QUESTION: The aim of the present study was to determine the association between self-report assessments of quality of life and objective measures of function in patients with symptomatic lumbar degenerative disease. Additionally, we evaluated the effect of lumbar spinal fusion surgery on this relationship. METHODS: Before and 6 month after surgery 26 patients completed self-report questionnaires and assessments of 3D gait analysis and trunk range of motion (ROM) during standing. RESULTS: Before surgery, questionnaires were not correlated with any of the gait parameters and with only 2 trunk ROM parameters. Six month after surgery, the questionnaires showed 12 significant correlations with gait parameters and 19 with trunk ROM parameters. A better Oswestry Disability Index (ODI) (râ¯=â¯0.464, pâ¯=â¯.026), EQ-5D (râ¯=â¯-0.440, pâ¯=â¯.036), and EQ VAS (râ¯=â¯-0.472, pâ¯=â¯.023) score were correlated with a reduced anterior thorax tilt during walking. Maximum forward flexion of the trunk during standing was correlated with a better EQ-5D (râ¯=â¯0.684, pâ¯=â¯.001) and ODI (râ¯=â¯-0.560, pâ¯=â¯.008) score as well as with reduced pain scores. SIGNIFICANCE: The lack of association between self-reported questionnaires and objective measures of function before surgery was likely due to psychological distress, correlating with emotional and cognitive function rather than true functional capacities. The influence of these psychological factors might be reduced after surgery due to a reduction of low back pain. To obtain an accurate assessment of impairment, there is a need to evaluate function by measuring objective physiologic parameters that are unsusceptible to voluntary or affective influences.
Asunto(s)
Degeneración del Disco Intervertebral/cirugía , Dolor de la Región Lumbar/cirugía , Vértebras Lumbares/cirugía , Calidad de Vida , Fusión Vertebral , Adulto , Anciano , Personas con Discapacidad , Femenino , Marcha/fisiología , Humanos , Degeneración del Disco Intervertebral/fisiopatología , Dolor de la Región Lumbar/fisiopatología , Vértebras Lumbares/fisiopatología , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Rango del Movimiento Articular/fisiología , Autoinforme , Encuestas y Cuestionarios , Torso/fisiopatologíaRESUMEN
STUDY DESIGN: This investigation prospectively compared self-assessed quality of life and biomechanical measures of physical function before and after spinal fusion surgery in 26 adult patients with symptomatic lumbar degenerative disease. OBJECTIVE: The objective was to demonstrate that (1) due to a reduction of low back pain, quality of life as well as gait parameters would improve after a spinal fusion surgery and (2) gait performance is more similar to that observed in healthy controls at the same age, whereas trunk range of motion remains unchanged after surgery. SUMMARY OF BACKGROUND DATA: Current outcome evaluations of spinal fusion surgery are based on radiological changes and self-report questionnaires. However, these traditional measures do not sufficiently assess the functionality. METHODS: Twenty-six patients with a mean age of 59.3 (SD: 10.1) years and 20 healthy subjects at the same age were evaluated. Before and approximately 6 months after a mono- or bisegmental spinal fusion surgery, patients completed self-report questionnaires and biomechanical assessments of gait analysis and trunk range of motion in the 3 principal planes of the body. RESULTS: Results indicated an improvement in quality of life as well as an increased pain-free walking distance, walking speed, step length, and maximum hip extension during the stance phase of gait. Anterior pelvis and thorax tilt were significantly reduced after the surgery without significant differences compared with the control group. Regarding the trunk range of motion, we observed a decrease in maximum forward flexion and an increase in the fingertip-floor distance after surgery. CONCLUSION: The study results show that lumbar spinal fusion is a useful procedure to improve patient's quality of life and gait performance. Although we performed only mono- and 2-level fusions, the sagittal alignment of the pelvis and thorax during walking was normalized. Clinical gait analysis contributes to the advancement of our knowledge regarding the functional changes after a spinal fusion surgery. LEVEL OF EVIDENCE: 2.