The Relationship Among Neuromuscular Impairments, Chronic Back Pain, and Mobility in Older Adults

Psychological and immunological associations with movement-evoked low back pain among older adults

Introduction

Low back pain (LBP) is a leading global factor in disability among older adults. Movement-evoked pain (MEP) is potentially an important mediator in the disability pathway but is predominantly tested in the laboratory.

Objectives

We aimed to explore MEP in the natural environment ("daily" MEP) and its correlation with laboratory MEP, along with potential psychological and immunological influences.

Method

Thirty-five older adults with persistent LBP attended a single laboratory session. Pain catastrophizing, pain-related fear of movement, and pain self-efficacy were measured by questionnaire. Resting inflammation and inflammatory reactivity to painful movement were evaluated using serum interleukin-6, tissue necrosis factor alpha, and C-reactive protein (CRP). Laboratory MEP was defined by aggregate pain intensity with a movement provocation test. Daily MEP was measured for the next 7 days using ecological momentary assessment.

Results

Laboratory MEP was strongly correlated with daily MEP (ρ = 0.780, P = <0.001). C-reactive protein (Hedges [g] = 0.266) and interleukin-6 (g = 0.433) demonstrated small to moderate reactivity to painful movement. After controlling for age and multimorbidity, pain catastrophizing and pain self-efficacy explained 24% to 37% variance in laboratory and daily MEP. Resting inflammatory markers were not associated with MEP; however, C-reactive protein reactivity to painful movement explained 19% to 25% variance in laboratory and daily MEP.

Conclusion

Preliminary indication is that laboratory and daily MEP may be proxy measures for one another, and that MEP is influenced by psychological and immunological factors. Future studies will aim to (1) validate findings among older adults with persistent LBP and (2) for clinical phenotyping, clarify complex relationships among psychological and immunological factors with disability pathway components like MEP.

The effect of pain on gait in older people: A systematic review and meta-analysis

Multi-site pain is common in people aged 60 years and over and is associated with a high risk of falls. To prevent and treat pain-related disabilities, it is crucial to identify the mechanisms underlying these associations. There is some evidence that pain leads to changes in walking, such as slower gait speed and shorter walking distance, which impair mobility and may increase the risk of falls. This review evaluated evidence on the relationship between pain and gait characteristics in older people. A comprehensive search on PubMed and Embase included observational studies and clinical trials assessing objective measures of walking, such as gait speed, cadence, stride length, and double-limb support time, in older people with and without pain. Of the 1218 studies screened, thirteen met the inclusion criteria from the primary search. An additional study was identified through the secondary search, resulting in fourteen studies included in this systematic review and meta-analysis. None of these studies investigated the relationship between fear of pain and gait characteristics in older people. Results showed that older people with pain had slower gait speed than those without pain, with a small effect size (Hedge's g = -0.30, 95% CI = -0.41 to -0.19, p < 0.0001). There were no statistically significant differences in cadence, stride length, and double-limb support time. These findings suggest that pain impacts walking speed in older people, highlighting the importance of addressing this association to manage mobility deficits and fall risk. PERSPECTIVE: This systematic review and meta-analysis show that pain is associated with reduced gait speed in older people. Recognising and addressing the impact of pain on walking may be important for preventing mobility-related disorders and falls in this population.

Considerations beyond spine pain: do different co-occurring lower body joint pains differentially influence physical function and quality of life ratings?

BACKGROUND

Patients seeking medical care for back pain often have coexisting painful joints and the effects of different combinations and number of coexisting pain sites (hip, knee, foot/ankle) to back pain on physical function domains and quality of life rating are not yet established. The purpose of this study was to determine the differences in functional outcomes and QOL among individuals with back pain who have concurrent additional pain sites or no pain sites.

METHODS

Data from the Osteoarthritis Initiative (OAI) cohort were used for this cross-sectional analysis. Men and women aged 45-79 years with back pain were binned into nine groups by presence or not of coexisting hip, knee, ankle/foot pain and combinations of these sites (N = 1,642). Healthy controls reported no joint pain. Main outcomes included Knee Injury and Osteoarthritis Outcome score (KOOS; quality of life and function-sports-and-recreation), Western Ontario McMaster Universities Osteoarthritis Index (WOMAC; Activities of Daily Living, Pain), Medical Outcomes Short Form-12 (SF-12) Physical Component score, and self-reported function in last 7-30 days (lifting 25-pound objects, housework). 20-m and 400-m walk times and gait speed and repeated chair rise test times were collected.

RESULTS

Compared to back pain alone, pain at all five sites was associated with 39%-86% worse KOOS, WOMAC, and SF-12 scores (p < .0001). Back-Hip and Back-Knee did not produce worse scores than Back pain alone, but Back-Hip-Knee and Back-Knee-Ankle/Foot did. The 20-m, 400-m walk, and repeated chair times were worse among individuals with pain at all five sites. Additional hip and knee sites to back pain, but not ankle/foot, worsened performance-based walk times and chair rise scores.

CONCLUSIONS

The number and type of coexistent lower body musculoskeletal pain among patients with back pain may be associated with perceived and performance-based assessments. Management plans that efficiently simultaneously address back and additional coexistent pain sites may maximize treatment functional benefits, address patient functional goals in life and mitigate disability.

Weight-cycling over 6 years is associated with pain, physical function and depression in the Osteoarthritis Initiative cohort

Body weight significantly impacts health and quality of life, and is a leading risk factor for the development of knee osteoarthritis (OA). Weight cycling may have more negative health consequences compared to steady high or low weight. Using the Osteoarthritis Initiative dataset, we investigated the effects of weight cycling on physical function, quality of life, and depression over 72-months compared to stable or unidirectional body weight trajectories. Participants (n = 731) had knee OA and were classified as: (1) stable-low (BMI < 25), (2) stable-overweight (BMI = 25-29.9), and (3) stable-obese (BMI ≥ 30); (4) steady-weight-loss; (5) steady-weight-gain (weight loss/gain ≥ 2.2 kg every 2-years); (6) gain-loss-gain weight cycling, and (7) loss-gain-loss weight cycling (weight loss/gain with return to baseline), based on bi-annual assessments. We compared Knee Injury and Osteoarthritis Outcome Knee-Related Quality of Life, Function in Sports and Recreation, Physical Activity in the Elderly, Short Form SF-12, repeated chair rise, 20-m gait speed, and Center for Epidemiological Studies Depression using repeated-measures ANOVA. The steady weight loss group demonstrated the worst pain, physical function, and depressive symptoms over time (p's < 0.05). More research is needed to confirm these findings, and elucidate the mechanisms by which steady weight loss is associated with functional decline in knee OA.

Is Tai Chi beneficial for multisite pain syndrome in older adults?

Chronic musculoskeletal pain is prevalent and undertreated in older adults. In particular, multisite pain is associated with serious functional consequences and falls and appears to be a novel geriatric syndrome. The causes of multisite pain are often multifactorial, and emerging evidence supports a complex pathway whereby multisite pain leads to cognitive problems, mobility decline, fear of falling, falls, and reduced participation in life roles. A few pharmacologic approaches are safe and effective for older adults with chronic multisite pain and evidence for effectiveness of non-pharmacologic treatments for this common condition is very limited. Compared to light physical exercise, mind-body exercise may prove to be more beneficial for older adults living with chronic pain. Tai Chi, as a movement-based mind-body exercise, can relieve pain symptoms, improve cognition and physical function, and lower risk for falls in older adults. However, little is known about the potential benefits of Tai Chi for older adults with multisite pain syndrome. Future large-scale randomized-controlled trials are needed to investigate the effectiveness of Tai Chi in alleviating pain and lowering fall risk in older adults with multisite pain, and the biological mechanisms that underlie its potential benefits to chronic pain, physical and cognitive functions, and falls in this at-risk population.

The Live Long Walk Strong Rehabilitation Program Study: Design and Methods

Objective

To identify attributes targeted by rehabilitative treatment within which improvements lead to short- and long-term changes in mobility. Maintaining independence in mobility is important to many older adults and is associated with critical outcomes such as aging in place, morbidity, and mortality.

Design

The Live Long Walk Strong rehabilitation study is a phase 2 single-blind, randomized controlled trial.

Setting

Veterans Affairs Boston Healthcare System, outpatient physical therapy.

Participants

198 community-dwelling middle- and older-aged veterans (aged 50 years and older) will be recruited from primary care practices (N=198).

Interventions

Comparing a moderate-vigorous intensity physical therapy program of 10 sessions with a waitlist control group.

Main Outcome Measure

The primary outcome measure is gait speed. Secondary outcomes include leg strength and power, trunk muscle endurance, gait smoothness, and exercise self-efficacy.

Results

Outcomes will be assessed within 2 weeks of intervention completion, at 8 weeks postintervention, and at 16 weeks postintervention. Two-sample t tests will compare mean change in gait speed and target attributes (leg power, trunk muscle endurance, gait smoothness, and exercise self-efficacy) between treatment and control groups. Paired t tests will examine within-person change at subsequent follow-up visits. Multivariable regression analyses will evaluate relationships between dependent and independent variables and potential mediation adjusting for relevant covariates.

Conclusions

Results of this study are expected to advance and refine the design of Live Long Walk Strong rehabilitative care and demonstrate its proof of concept and efficacy.

A Standardized Assessment of Movement-evoked Pain Ratings Is Associated With Functional Outcomes in Older Adults With Chronic Low Back Pain

OBJECTIVE

Despite high prevalence estimates, chronic low back pain (CLBP) remains poorly understood among older adults. Movement-evoked pain (MeP) is an understudied factor in this population that may importantly contribute to disability. This study investigated whether a novel MeP paradigm contributed to self-reported and performance-based function in older adults with CLBP.

MATERIALS AND METHODS

This secondary analysis includes baseline data from 230 older adults with CLBP in the context of a prospective cohort study. The Repeated Chair Rise Test, Six Minute Walk Test, and Stair Climbing Test were used to elicit pain posttest LBP ratings were aggregated to yield the MeP variable. Self-reported and performance-based function were measured by the Late Life Function and Disability Index (LLFDI) scaled function score and Timed Up-and-Go Test (TUG), respectively. Robust regression with HC3 standard errors was used to model adjusted associations between MeP and both functional outcomes; age, sex, body mass index, and pain characteristics (ie, intensity, quality, and duration) were utilized as covariates.

RESULTS

MeP was present in 81.3% of participants, with an average rating of 5.09 (SD=5.4). Greater aggregated posttest MeP was associated with decreased LLFDI scores (b=-0.30, t=-2.81, P=0.005) and poorer TUG performance (b=0.081, t=2.35, P=0.020), independent of covariates. LBP intensity, quality and duration were not associated with the LLFDI or TUG, (all P>0.05).

DISCUSSION

Aggregated posttest MeP independently contributed to worse self-reported and performance-based function among older adults with CLBP. To understand long-term consequences of MeP, future studies should examine longitudinal associations between MeP and function in this population.

Association of Back Pain with Mortality: a Systematic Review and Meta-analysis of Cohort Studies

BACKGROUND

Back pain is the most common cause of disability worldwide. While disability generally is associated with greater mortality, the association between back pain and mortality is unclear. Our objective was to examine whether back pain is associated with increased mortality risk and whether this association varies by age, sex, and back pain severity.

METHODS

A systematic search of published literature was conducted using PubMed, Web of Science, and Embase databases from inception through March 2019. We included English-language prospective cohort studies evaluating the association of back pain with all-cause mortality with follow-up periods >5 years. Three reviewers independently screened studies, abstracted data, and appraised risk of bias using the Quality in Prognosis Studies (QUIPS) tool. A random-effects meta-analysis estimated combined odds ratios (OR) and 95% confidence intervals (CI), using the most adjusted model from each study. Potential effect modification by a priori hypothesized factors (age, sex, and back pain severity) was evaluated with meta-regression and stratified estimates.

RESULTS

We identified eleven studies with 81,337 participants. Follow-up periods ranged from 5 to 23 years. The presence of any back pain, compared to none, was not associated with an increase in mortality (OR, 1.06; 95% CI, 0.97 to 1.16). However, back pain was associated with mortality in studies of women (OR, 1.22; 95% CI, 1.02 to 1.46) and among adults with more severe back pain (OR, 1.26; 95% CI, 1.14 to 1.40).

CONCLUSION

Back pain was associated with a modest increase in all-cause mortality among women and those with more severe back pain.

Classification of Geriatric Low Back Pain Based on Hip Characteristics With a 12-Month Longitudinal Exploration of Clinical Outcomes: Findings From Delaware Spine Studies

OBJECTIVE

The purpose of this study is to identify geriatric chronic low back pain (LBP) subgroups based on the presence of potentially modifiable hip impairments, using Latent Variable Mixture Modeling (LVMM), and to examine the prospective relationship between these subgroups and key outcomes over time.

METHODS

Baseline, 3-month, 6-month, and 12-month data were collected from a prospective cohort of 250 community-dwelling older adults with chronic LBP. Comprehensive hip (symptoms, strength, range of motion, and flexibility), LBP (intensity and disability), and mobility function (gait speed and 6-Minute Walk Test) examinations were performed at each timepoint. Baseline hip measures were included in LVMM; observed classes/subgroups were compared longitudinally on LBP and mobility function outcomes using mixed models.

RESULTS

Regarding LVMM, a model with 3 classes/subgroup fit best. Broadly speaking, subgroups were differentiated best by hip strength and symptom presence: subgroup 1 = strong and nonsymptomatic, subgroup 2 = weak and nonsymptomatic, and subgroup 3 = weak and symptomatic (WS). Regarding longitudinal mixed models, all subgroups improved in most outcomes over time. Specifically, over 12 months, the nonsymptomatic subgroups had lower LBP intensity and disability levels compared with the WS subgroup, whereas the strong and nonsymptomatic subgroup had better mobility function than the 2 "weak" subgroups.

CONCLUSION

These subgroup classifications may help in tailoring specific interventions in future trials. Special attention should be given to the WS subgroup given their consistently poor LBP and mobility function outcomes.

IMPACT

Among older adults with chronic low back pain, there are 3 hip subgroups: "strong and nonsymptomatic," "weak and nonsymptomatic," and "weak and symptomatic." People in these subgroups demonstrate different outcomes and require different treatment; proper identification will result in tailored interventions designed to benefit individual patients. In particular, people in the WS subgroup deserve special attention, because their outcomes are consistently poorer than those in the other subgroups.

Pain Is Associated With Poor Balance in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis

OBJECTIVES

Pain is a risk factor for falls in older adults, but the mechanisms are not well understood, limiting our ability to implement effective preventive strategies. The aim of this study was to systematically review and synthesize the literature that has examined the impact of pain on static, dynamic, multicomponent, and reactive balance in community-dwelling older adults.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Studies from inception to March 2019 were identified from electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL), contact with the primary authors, and reference lists of included articles.

METHODS

Cross-sectional and case-control studies that compared objective balance measures between older (minimum age 60 years) adults with and without pain were included.

RESULTS

Thirty-nine eligible studies (n = 17,626) were identified. All balance modalities (static, dynamic, multicomponent, and reactive) were significantly poorer in participants with pain compared to those without pain. Subgroup analyses revealed that chronic pain (pain persisting ≥3 months) impaired balance more than pain of unspecified duration. The effects of pain at specific sites (neck, lower back, hip, knee, and foot) on balance were not significantly different.

CONCLUSIONS AND IMPLICATIONS

Pain is associated with poor static, dynamic, multicomponent, and reactive balance in community-dwelling older adults. Pain in the neck, lower back, hip, knee, and foot all contribute to poor balance, and this is even more pronounced for chronic pain. Comprehensive balance and pain characteristic assessments may reveal mechanisms underlying the contribution of pain to instability and increased fall risk in older people.

Chronic Musculoskeletal Pain and Foot Reaction Time in Older Adults

This cross-sectional study examines the association between chronic musculoskeletal pain and foot reaction time (RT) among older community-living adults. Participants were 307 adults aged 71 years and older in the MOBILIZE Boston Study II. Pain severity, interference, and location were measured by the Brief Pain Inventory and a joint pain questionnaire. With participants seated, simple foot reaction time was measured as self-selected foot response time to an intermittent light, and choice foot reaction time was measured as response time to the light on the corresponding side of the sensored gait mat. We performed multivariable linear regression to determine associations of pain and foot RT, adjusted for sociodemographic and health characteristics, and serially adjusted for cognitive function (MMSE or Trail Making A). Pain severity and interference were associated with slower simple foot reaction time (P < .05). Pain severity and knee pain were associated with slower choice foot reaction time (P < .05). Adjustment for cognitive measures had little impact on the pain-RT relationship. This significant relationship was only observed among participants with less education. These results support the idea that chronic pain may lead to slower foot RT, thus could represent a fall hazard in older adults. Neuromotor mechanisms underlying the pain-fall relationship warrant further investigation. PERSPECTIVE: This study provides insights on the mechanisms underlying the pain-fall relationship. Chronic pain may contribute to slower foot RT thus increase fall risk in older adults. This may help inform interventions such as stepping training to reduce fall risk in older adults living with chronic pain.

Interrelated Neuromuscular and Clinical Risk Factors That Contribute to Falls

BACKGROUND

Neuromuscular and clinical factors contribute to falls among older adults, yet the interrelated nature of these factors is not well understood. We investigated the relationships between these factors and how they contribute to falls, which may help optimize fall risk assessment and prevention.

METHODS

A total of 365 primary care patients (age = 77 ± 7, 67% female) were included from the Boston Rehabilitative Impairment Study of the Elderly. Neuromuscular measures included leg strength and leg velocity, trunk extensor endurance, and knee range of motion. Clinical measures included memory, executive function, depressive symptoms, pain, sensory loss, vision, comorbidity, physical activity, mobility self-efficacy, and psychiatric medication. Factor analysis was used to evaluate clustering of factors. Negative binomial regression assessed the relationship of factors with three-year fall rate. Interactions were tested to examine whether clinical factors modified the relationship between neuromuscular factors and falls.

RESULTS

Three factors emerged: (i) neuromuscular factors, pain, and self-efficacy; (ii) memory; and (iii) executive function. Having three neuromuscular impairments predicted higher fall rate (incidence rate ratio [95% confidence interval]: 3.39 [1.82-6.32]) but was attenuated by memory (1.69 [1.10-2.61]), mobility self-efficacy (0.99 [0.98-0.99]), psychiatric medication use (1.54 [1.10-2.14]), and pain (1.13 [1.04-1.23]). Pain modified the relationship between neuromuscular impairment burden (number of neuromuscular impairments) and falls. Having three neuromuscular impairments was associated with a higher fall rate in patients with high levels of pain (5.73 [2.46-13.34]) but not among those with low pain.

CONCLUSIONS

Neuromuscular impairment burden was strongly associated with fall rate in older adults with pain. These factors should be considered together during fall risk assessment, post fall assessment, and prevention.

Using Pain Medication Intensity to Stratify Back Pain Among Older Adults

Objective

To examine the prevalence of musculoskeletal back pain among older adults stratified by pain medication intensity to 1) review treatment patterns and 2) consider targeted back pain prevention interventions.

Methods

A random sample of older adults age 64 years and older was utilized to identify new and recurring back pain. Prescription pain medications from drug claims were used to stratify to five unique intensity levels. The characteristics of each level were determined using regression models.

Results

About 10% had musculoskeletal back pain. Of these, 54% (N = 20,645) had new back pain and 46% (N = 17,252) had recurring back pain. Overall, about 35% received physical therapy. Pain medication intensity levels included no prescription pain medications, nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, low-dose opioids, and high-dose opioids (new back pain: 39%, 10%, 6%, 23%, and 23%, respectively; recurring back pain 32%, 9%, 4%, 17%, and 38%, respectively). NSAID and muscle relaxant users were younger, healthier, and received physical therapy. Opioid users were younger, in poorer health, used sleep medications, received physical therapy, and had more falls and higher health care utilization and expenditures.

Conclusions

New and recurring back pain patients can be stratified by pain medication intensity to review treatment patterns and target back pain prevention programs. Those with back pain but taking no prescription pain medications may benefit from back pain prevention programs. More research on guidelines for treatment options for those on high levels of pain medications is warranted.

The Association of Pain Phenotype with Neuromuscular Impairments and Mobility Limitations Among Older Primary Care Patients: A Secondary Analysis of the Boston Rehabilitative Impairment Study of the Elderly

BACKGROUND

Clarifying the relationship between pain phenotypes and physical function in older adults may enhance screening and treatment for functional decline in primary care settings.

OBJECTIVE

To investigate the association of more severe pain phenotypes with neuromuscular impairments or mobility limitations among older community-dwelling primary care patients.

DESIGN

Cross-sectional analysis.

SETTING

The Boston Rehabilitative Impairment Study of the Elderly.

PARTICIPANTS

Adults aged 65 years or older.

METHODS

We counted the number of musculoskeletal pain locations (none, single site, multisite, or widespread) using the McGill Pain Questionnaire and identified pain intensity tertiles using the Brief Pain Inventory. Neuromuscular attributes (trunk extensor muscle endurance, and leg speed, strength, strength asymmetry, and range of motion) and mobility (Short Physical Performance Battery [SPPB]) were assessed with performance-based measures. Additionally, self-reported mobility was measured on the Late Life Function and Disability Instrument (LLFDI). For neuromuscular attributes and LLFDI, scores in the lowest tertile indicated neuromuscular impairment or mobility limitations, respectively. For SPPB, a score <7 (of 12) indicated severe mobility limitations.

RESULTS

Among 430 participants (mean age = 77) most were female (68%), white (83%), and had either multisite (50%) or widespread (14%) pain. After adjusting for baseline characteristics, widespread pain (compared to none) was associated with slow leg speed (adjusted odds ratio, 95% confidence interval: aOR = 2.33, 1.03-5.27), limited ankle range of motion (aOR = 2.15, 1.03-4.47) and mobility limitations on LLFDI (aOR = 3.85, 1.81-8.19). Being in the highest pain intensity tertile, versus lowest tertile, was associated with poor trunk extensor muscle endurance (aOR = 2.49, 1.41-4.39), limited ankle range of motion (aOR = 2.15, 1.25-3.71), and mobility limitations on SPPB (aOR = 2.56, 1.45-4.52), and LLFDI (aOR = 4.70, 2.63-8.40).

CONCLUSIONS

Among ambulatory, older primary care patients, more severe pain phenotypes are associated with neuromuscular impairments identified on physical testing and mobility limitations on validated measures.

Chronic Pain Characteristics and Gait in Older Adults: The MOBILIZE Boston Study II

OBJECTIVE

To investigate a proposed cognitively-mediated pathway whereby pain contributes to gait impairments by acting as a distractor in community-living older adults.

DESIGN

A cross-sectional study of a population-based cohort of older adults.

SETTING

Urban and suburban communities in a large metropolitan area.

PARTICIPANTS

Community-living participants (N=302) 70 years and older recruited from a previous population-based cohort.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Gait parameters including gait speed, stride length, double support and swing characteristics, and variability were assessed under single- and dual-task conditions involving cognitive challenges (eg, counting backward). A joint pain questionnaire assessed pain distribution in the back and major joints. We examined pain-gait relationships using multivariable linear regression and bootstrapping mediation procedures.

RESULTS

Forty-three percent of participants had pain in 2 or more musculoskeletal sites. Pain distribution was related to slower gait speed and other gait characteristics for all gait conditions. Associations persisted after adjustment for age, sex, education, body mass index, medication, and vision. Decrements in gait measures related to pain were comparable with decrements in gait related to dual-task conditions. There were no differences in dual-task cost among the pain distribution groups. Adjusted for confounders, pain-gait relationships appear mediated by selective attention.

CONCLUSIONS

These findings suggest that chronic pain contributes to decrements in gait, including slower gait speed, and that it operates through a cognitively-mediated pathway. Further research is needed to understand the mechanisms via pain alters mobility and to develop interventions to improve mobility among older adults with chronic pain.

The Double-Transforaminal Lumbar Interbody Fusion: An Innovative One-Stage Surgical Technique for Posterior Kyphosis Correction

Posttraumatic deformities after vertebral fractures are challenging for orthopedic surgeons in the non-operative and operative field. Especially osteoporotic fractures may cause a hyperkyphosis resulting in segmental or global sagittal imbalance and chronic back pain. Different vertebral osteotomies are potent to restore sagittal profile but show a very high perioperative risk including neurological and soft tissue complications. In addition, some of these extensive operations require a two-step procedure including posterior and anterior approaches. Therefore, these established techniques may be contraindicated in elderly or multimorbide patients suffering from concomitant diseases. The authors describe the double transforaminal lumbar interbody fusion (TLIF) osteotomy (DTO) as an innovative one-stage and low-invasive surgical technique to correct a fixed posttraumatic kyphosis in the thoracolumbar junction. The procedure includes posterior release (laminectomy, facettectomy, nucleotomy) combined with two expandable TLIF implants (sandwich technique) and posterior instrumentation and is illustrated by a case of a multimorbide 78-year old female.

Association of Neuromuscular Attributes With Performance-Based Mobility Among Community-Dwelling Older Adults With Symptomatic Lumbar Spinal Stenosis

OBJECTIVES

To identify differences in health factors, neuromuscular attributes, and performance-based mobility among community-dwelling older adults with symptomatic lumbar spinal stenosis; and to determine which neuromuscular attributes are associated with performance-based measures of mobility.

DESIGN

Cross-sectional; secondary data analysis of a cohort study.

SETTING

Outpatient rehabilitation center.

PARTICIPANTS

Community-dwelling adults aged ≥65 years with self-reported mobility limitations and symptomatic lumbar spinal stenosis (N=54).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Short Physical Performance Battery score, habitual gait speed, and chair stand test.

RESULTS

Symptomatic lumbar spinal stenosis was classified using self-reported symptoms of neurogenic claudication and imaging. Among 430 community-dwelling older adults, 54 (13%) met criteria for symptomatic lumbar spinal stenosis. Compared with participants without symptomatic lumbar spinal stenosis, those with symptomatic lumbar spinal stenosis had more comorbidities, higher body mass index, greater pain, and less balance confidence. Participants with symptomatic lumbar spinal stenosis had greater impairment in trunk extensor muscle endurance, leg strength, leg strength asymmetry, knee flexion range of motion (ROM), knee extension ROM, and ankle ROM compared with participants without symptomatic lumbar spinal stenosis. Five neuromuscular attributes were associated with performance-based mobility among participants with symptomatic lumbar spinal stenosis: trunk extensor muscle endurance, leg strength, leg strength asymmetry, knee flexion ROM, and knee extension ROM asymmetry.

CONCLUSIONS

Community-dwelling older adults with self-reported mobility limitations and symptomatic lumbar spinal stenosis exhibit poorer health characteristics, greater neuromuscular impairment, and worse mobility when compared with those without symptomatic lumbar spinal stenosis. Poorer trunk extensor muscle endurance, leg strength, leg strength asymmetry, knee flexion ROM, and knee extension ROM asymmetry were associated with performance-based mobility among participants with symptomatic lumbar spinal stenosis.