Changes of balance control in individuals with lumbar degenerative spine disease after lumbar surgery: a longitudinal study

Abstract

Background context: Lumbar degenerative spine disease (DSD) with neurological symptoms is the most common indication requiring lumbar surgery when nonoperative treatment is not effective. Individuals with lumbar DSD have sensory, proprioception, and musculoskeletal system alterations, which may result in balance impairment. However, evidence regarding balance recovery in individuals with lumbar DSD after lumbar surgery is limited.

Purpose: To evaluate balance control, pain, and functional activities in individuals with lumbar DSD after lumbar surgery.

Study design/setting: A prospective study with a cross-sectional control group.

Patient sample: Seventy individuals with lumbar DSD (DSD group) and 30 age-matched healthy adults (control group) were recruited. Participants in the DSD group were diagnosed by a neurological surgeon and received lumbar surgery according to relevant imaging findings and neurological symptoms.

Outcome measures: Clinical assessments, including a visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the Roland-Morris Disability Questionnaire (RMDQ), were performed in the DSD group only. Balance control was assessed in all participants using the root mean square (RMS) distance of the center of pressure (COP) in anteroposterior and mediolateral directions.

Methods: All participants were instructed to stand in natural stance and Romberg stance with eyes open and eyes closed on a force platform for 35 seconds, respectively. The assessments were performed in the DSD group at four time points: preoperative phase (baseline), 3 months, 6 months, and 12 months postoperatively. In the age-matched healthy control group, only one assessment on the recruitment day was performed.

Results: The VAS, ODI, and RMDQ scores of the DSD group significantly improved after lumbar surgery (p<.001). The RMS distance of COP in the DSD group significantly decreased after lumbar surgery (p<.017) compared with baseline in most of the testing conditions. However, the RMS distance of the COP in the DSD group after surgery was significantly greater than in the healthy control group (p<.05), especially 6 months and 12 months postoperatively.

Conclusions: Balance control, pain, and functional activities of individuals with lumbar DSD showed improvement after lumbar surgery. However, balance control in individuals with lumbar DSD was still less stable than in age-matched healthy adults from 6 to 12 months after surgery. Therefore, individuals with lumbar DSD require fall prevention programs after lumbar surgery, including balance assessments and postoperative balance training.

Keywords: Balance control; Biomechanics; Center of pressure (COP); Functional assessment; Lumbar degenerative spine disease (DSD); Lumbar surgery.