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Clinical and gait profile of patients with lumbar disc herniation manifested as acute sciatica versus healthy controls: a case-control study
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Introdução: A hérnia discal é o diagnóstico mais comum entre as alterações degenerativas da coluna lombar. Em aproximadamente 85–90% dos casos a hérnia discal causa ciática aguda. Tais alterações degenerativas apresentam padrões específicos de deterioração da marcha. Informação acerca de parâmetros da marcha reporta a existência de aumentos nos parâmetros temporais e diminuições nos parâmetros espaciais quando comparados com indivíduos saudáveis. Objetivo: Caracterizar variáveis clínicas e características biomecânicas dos parâmetros da marcha em pacientes com hérnias discal manifestada como ciática aguda e comparar os parâmetros de marcha com os de indivíduos saudáveis. Também, determinar como estas variáveis se correlacionam com outcomes clínicos. Metodologia: Foi realizado um estudo de caso-controlo com uma amostra de 19 indivíduos com hérnia discal lombar e 17 indivíduos saudáveis. Outcomes clínicos e parâmetros espaciotemporais da marcha foram avaliados. Parâmetros de marcha foram avaliados presencialmente com recurso a IMUs e avaliação de outcomes clínicos através de questionários. Resultados: Diferenças significativas entre os grupos foram encontradas nos parâmetros da marcha. Valores superiores no grupo de hérnia discal foram encontrados nos parâmetros espaciotemporais stride, step e stance time, swing time (lado sintomático), double support e single support time (lado não sintomático). Valores superiores no grupo saudável foram encontrados nos parâmetros speed, cadence, stride e step length. Índice de massa corporal ajustado como covariável influenciou o parâmetro double support time, que deixou de apresentar diferença entre grupos. Correlações significativas foram encontradas entre resultados da ODI, EQ-5D-3L, NPRS basal e pico do membro inferior e parâmetros espaciotemporais. Uma correlação forte foi encontrada entre a ODI e stance time (lado não sintomático). Intensidade da dor “pico” do membro inferior foi significativamente diferente entre o grupo severo e não severo da hérnia discal, com valores superiores no grupo severo. Conclusão: Pacientes com hérnia discal manifestada como ciática aguda apresentam alterações de marcha caracterizadas por diminuições nos parâmetros espaciais e aumentos nos parâmetros temporais quando comparados com indivíduos saudáveis. Apresentam variabilidade na intensidade da dor axial e valores altos de dor no membro inferior afetado. Estas alterações correlacionam-se com maior incapacidade, menor qualidade de vida e maior intensidade da dor.
Introduction: Lumbar disc herniation (LDH) is the most common diagnosis among the degenerative abnormalities of the lumbar spine. In approximately 85–90% of cases, a herniated disc causes acute sciatica. Degenerative diseases such as LDH have unique patterns of gait deterioration. Information on gait parameters reports alterations including increases in temporal parameters and decreases in spatial parameters when compared to healthy controls. Aim: To characterize clinical and biomechanical gait characteristics in patients with LDH manifested as acute sciatica and compare gait variables parameters with healthy individuals. Also, to determine how these variables correlate with clinical outcomes. Methodology: A case-control study was carried out with a sample of 19 LDH patients and 17 healthy individuals. Clinical outcomes and spatiotemporal gait parameters were assessed. Gait parameters were assessed via onsite gait analysis with IMU’s and clinical outcomes via clinical questionnaires. Results: Significant differences were found in gait parameters when comparing the LDH group with the healthy group, higher values in spatiotemporal gait parameters were found in the LDH group for stride time, step time, stance time, swing time (symptomatic side), double support time (non-symptomatic side) and single support time (non-symptomatic side). Higher values in spatiotemporal gait parameters were found in the healthy group for speed, cadence, stride length and step length. Body mass index adjusted as a covariate influenced double support time which no longer was different between groups. Significant correlations were found between ODI scores, EQ-5D-3L index values, baseline and peak NPRS leg pain scores and spatiotemporal parameters. A strong correlation was found between ODI and stance time (non-symptomatic side). Pain scores of lower limb peak pain differed significantly between severe and non-severe LDH, with higher scores in severe patients. Conclusion: Patients with LDH manifested as acute sciatica exhibit gait alterations characterized by decreases in spatial parameters and increases in temporal parameters when compared to healthy individuals. They present a variability of axial pain scores and high levels of pain scores in the affected lower leg. These alterations correlate with higher pain intensity, greater disability levels and lower health-related quality of life.
Introduction: Lumbar disc herniation (LDH) is the most common diagnosis among the degenerative abnormalities of the lumbar spine. In approximately 85–90% of cases, a herniated disc causes acute sciatica. Degenerative diseases such as LDH have unique patterns of gait deterioration. Information on gait parameters reports alterations including increases in temporal parameters and decreases in spatial parameters when compared to healthy controls. Aim: To characterize clinical and biomechanical gait characteristics in patients with LDH manifested as acute sciatica and compare gait variables parameters with healthy individuals. Also, to determine how these variables correlate with clinical outcomes. Methodology: A case-control study was carried out with a sample of 19 LDH patients and 17 healthy individuals. Clinical outcomes and spatiotemporal gait parameters were assessed. Gait parameters were assessed via onsite gait analysis with IMU’s and clinical outcomes via clinical questionnaires. Results: Significant differences were found in gait parameters when comparing the LDH group with the healthy group, higher values in spatiotemporal gait parameters were found in the LDH group for stride time, step time, stance time, swing time (symptomatic side), double support time (non-symptomatic side) and single support time (non-symptomatic side). Higher values in spatiotemporal gait parameters were found in the healthy group for speed, cadence, stride length and step length. Body mass index adjusted as a covariate influenced double support time which no longer was different between groups. Significant correlations were found between ODI scores, EQ-5D-3L index values, baseline and peak NPRS leg pain scores and spatiotemporal parameters. A strong correlation was found between ODI and stance time (non-symptomatic side). Pain scores of lower limb peak pain differed significantly between severe and non-severe LDH, with higher scores in severe patients. Conclusion: Patients with LDH manifested as acute sciatica exhibit gait alterations characterized by decreases in spatial parameters and increases in temporal parameters when compared to healthy individuals. They present a variability of axial pain scores and high levels of pain scores in the affected lower leg. These alterations correlate with higher pain intensity, greater disability levels and lower health-related quality of life.
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Hérnia discal lombar Ciática Parâmetros espaciotemporais Dor Incapacidade Qualidade de vida relacionada com a saúde Lumbar disc herniation Sciatica Spatiotemporal gait parameters Pain Disability Health-related quality of life.