Gait analysis, trunk movements, and electromyographic patterns after minimally invasive spine surgery for lumbar instability: An observational prospective study

Massimo Miscusi; Mariano Serrao; Luca Ricciardi; Carmela Conte; Stefano Filippo Castiglia; Giorgio Ippolito; Gianluca Coppola; Stefano Forcato; Alba Scerrati; Antonino Raco

doi:10.1016/j.wnsx.2023.100262

Gait analysis, trunk movements, and electromyographic patterns after minimally invasive spine surgery for lumbar instability: An observational prospective study

World Neurosurg X. 2023 Dec 11:21:100262. doi: 10.1016/j.wnsx.2023.100262. eCollection 2024 Jan.

Authors

Massimo Miscusi¹, Mariano Serrao^{2

3}, Luca Ricciardi¹, Carmela Conte^{2

3}, Stefano Filippo Castiglia^{2

4}, Giorgio Ippolito², Gianluca Coppola², Stefano Forcato⁵, Alba Scerrati⁶, Antonino Raco¹

Affiliations

¹ Department of NESMOS, Sapienza University, via di Grottarossa 1035-1039, Rome, Italy.
² Department of Medical and Surgical Sciences and Biotechnologies, Sapienza, University of Rome - Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.
³ Movement Analysis LAB, Policlinico Italia, Piazza del Campidano 6, 00162, Rome Italy.
⁴ Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy.
⁵ UO di Neurochirurgia, Pia Fondazione di Culto e Religione Cardinale G. Panico, Via San Pio X 4, 73039, Tricase, Italy.
⁶ Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Università di Ferrara, via Luigi Borsari 46, 44121 Ferrara, Italy.

Abstract

Objective: The aim of the present study was to investigate trunk kinematics and spine muscle activation during walking after minimally invasive surgery in patients with L4-L5 degenerative spondylolisthesis suffering from lumbar instability (LI).

Methods: Eleven patients suffering from LI and 13 healthy controls (HC) were enrolled. Trunk kinematics and spine muscle activation patterns during walking were collected. Maximal trunk ranges of motion were also recorded from standing position. Assessments were performed pre-operatively (T0), 1 month (T1) and 3 months (T2) after MIS.

Results: We found significant improvement in spine muscle activation during walking at T2 compared to T0, mainly involving right/left symmetry at the operated level (L4-L5) and up-down synchronization from L3 to S1. Significant improvements in trunk rotation nearing to the HC group during walking were also found at T2 after surgery, though no changes were observed in the maximal range of motion of the trunk during standing. Furthermore, trunk rotation improvement correlated with a lower grade of residual disability.

Conclusions: Our findings indicate that trunk rotation improves after surgery, and impaired aspects of spine muscle activation can be improved with surgery. These biomechanical parameters could represent novel tools for monitoring the effect of surgery in LI and preventing impaired spine mobility and muscle activation.

Keywords: Center of activity; Cross-correlation; Low back pain; Spine muscle activation; Surface electromyography; Surgical procedures; Vertebral column.