Abstract:BackgroundLumbar spinal stenosis (LSS) causing neurogenic claudication is a leading cause of pain, disability and loss of independence in older adults. The prevalence of lumbar spinal stenosis is growing rapidly due to an aging population. The dominant limitation in LSS is walking ability. Postural, physical and psychosocial factors can impact symptoms and functional ability. LSS is the most common reason for spine surgery in older adults yet the vast majority of people with LSS receive non-surgical treatment.… Show more
“…Results favoured 'intense' rehabilitation programs of care. A detailed description of the multimodal rehabilitation program is available elsewhere 3 .…”
Section: Comparisons With Other Cpgs and Reviews On The Management Of Lssmentioning
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
“…Results favoured 'intense' rehabilitation programs of care. A detailed description of the multimodal rehabilitation program is available elsewhere 3 .…”
Section: Comparisons With Other Cpgs and Reviews On The Management Of Lssmentioning
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
“…Lumbar stenosis is one of the leading sources of lower back pain worldwide. It is defined as a narrowing of the lumbar spinal canal [ 1 ] due to degeneration of the spinal canal and neural foramen. An estimated 73 million people will be over the age of 65 of which 30% are projected to have symptomatic lumbar spinal stenosis in the US by the year 2030 [ 1 ].…”
Section: Introductionmentioning
confidence: 99%
“…It is defined as a narrowing of the lumbar spinal canal [ 1 ] due to degeneration of the spinal canal and neural foramen. An estimated 73 million people will be over the age of 65 of which 30% are projected to have symptomatic lumbar spinal stenosis in the US by the year 2030 [ 1 ]. Surgery is typically required for patients with lumbar stenosis over the age of 65 years [ 2 ].…”
Facetectomy is an important intervention for spinal stenosis but may lead to spinal instability. Biomechanical knowledge for facetectomy can be beneficial when deciding whether fusion is necessary. Therefore, the aim of this study was to investigate the biomechanical effect of different grades of facetectomy. A three-dimensional nonlinear finite element model of L3–L5 was constructed. The mobility of the model and the intradiscal pressure (IDP) of L4-L5 for standing were inside the data from the literature. The effect of graded facetectomy on intervertebral rotation, IDP, facet joint forces, and maximum von Mises equivalent stresses in the annuli was analyzed under flexion, extension, left/right lateral bending, and left/right axial rotation. Compared with the intact model, under extension, unilateral facetectomy increased the range of intervertebral rotation (IVR) by 11.7% and IDP by 10.7%, while the bilateral facetectomy increased IVR by 40.7% and IDP by 23.6%. Under axial rotation, the unilateral facetectomy and the bilateral facetectomy increased the IVR by 101.3% and 354.3%, respectively, when turned to the right and by 1.1% and 265.3%, respectively, when turned to the left. The results conclude that, after unilateral and bilateral facetectomy, care must be taken when placing the spine into extension and axial rotation posture from the biomechanical point of view.
“…This will be a nested study within a larger RCT. 19 Fig 1 Process of recruitment, randomization, and outcomes assessment. TENS , transcutaneous electrical nerve stimulation.…”
BackgroundLumbar spinal stenosis (LSS) is a growing health problem and a leading cause of disability and loss of independence in older adults. It is usually caused by age-related degenerative narrowing of the spinal canals leading to compression and ischemia of the spinal nerves and symptoms of neurogenic claudication. Limited walking ability is the dominant functional impairment caused by LSS. Animal studies suggest increased blood flow to the spinal nerves and spinal cord with superficial paraspinal electrical stimulation. The purpose of this study is to assess the effectiveness of paraspinal transcutaneous electrical nerve stimulation (TENS) applied while walking on walking ability in patients with LSS.Methods/DesignWe propose to conduct a 2-arm double-blinded (participant and assessor) randomized controlled trial. We will recruit individuals who have limited walking ability due to degenerative LSS from hospital specialists, community physicians, and chiropractors located in the city of Toronto, Canada. Eligible consenting participants will be randomly assigned to either paraspinal TENS or placebo paraspinal TENS applied while walking. The primary outcome will be walking distance measured during a single self-paced walking test. We will calculate the differences in proportions among participants in both groups who achieve at least a 30% improvement in walking distance from baseline using Pearson χ2 test with 95% confidence intervals.DiscussionEffective nonoperative interventions for LSS are unknown. Interventions that can improve blood flow to the spinal nerves while walking may increase walking ability in this population. Transcutaneous electrical nerve stimulation is a low-cost intervention that may have the potential to achieve this objective. To our knowledge, this study will be the first clinical trial to assess the effects of TENS on walking ability of patients with LSS.Trial RegistrationClinicalTrials.gov ID: NCT02592642
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