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Comparison of effects of nonoperative treatment and decompression surgery on risk of patients with lumbar spinal stenosis falling: Evaluation with functional mobility tests

Authors
 Byung Ho Lee  ;  Tae-Hwan Kim  ;  Moon-Soo Park  ;  Suhan Lim  ;  Jin-Oh Park  ;  Hak-Sun Kim  ;  Ho-Joong Kim  ;  Hwan-Mo Lee  ;  Seong-Hwan Moon 
Citation
 JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, Vol.96(13) : 110, 2014 
Journal Title
 JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME 
ISSN
 0021-9355 
Issue Date
2014
MeSH
Accidental Falls* ; Aged ; Decompression, Surgical ; Disability Evaluation ; Female ; Humans ; Lumbar Vertebrae*/surgery ; Male ; Middle Aged ; Postural Balance/physiology* ; Quality of Life ; Range of Motion, Articular/physiology ; Risk ; Spinal Stenosis/surgery ; Spinal Stenosis/therapy* ; Treatment Outcome
Abstract
Background: Falls are a major factor contributing to fragility fractures. Patients with lumbar spinal stenosis have an increased risk of falling. We are aware of no prior report demonstrating the effect of medical treatment and decompression surgery on the risk of patients with lumbar spinal stenosis falling. Methods: From June to November 2011, seventy-six patients were enrolled into the surgery group and fifty patients, into the nonoperative group. Four functional mobility tests, including the Alternate-Step test, Six-Meter Walk test, Sit-to-Stand test, and timed “Up & Go” test, were used to evaluate the risk of falling. The Oswestry Disability Index (ODI) and the EuroQoL-5D (EQ-5D) visual analog scale (VAS) were utilized to assess clinical improvement. Results: The mean age was 62.4 years in the surgery group and 64.6 years in the nonoperative group. The results of the Alternate-Step test significantly improved during the follow-up period in the surgery group (p = 0.001). However, the results of the Alternate-Step test significantly worsened during the follow-up period in the nonoperative group (p = 0.001). Comparison between the two groups showed more significant improvement in the surgery group, especially for the Six-Meter Walk test at one year postoperatively (p = 0.042) and for the timed “Up & Go” test at three months and one year (p = 0.046 and 0.000). However, the ODI and EQ-5D VAS scores improved in both groups. In a linear mixed model, age, surgery, and the presence of an osteoporotic compression fracture significantly affected the test results related to the risk of falling (p < 0.05). Conclusions: The surgery group showed a greater decrease in the risk of falling than those in the nonoperative group. Improved physical performance, including walking and balancing, after decompression lumbar spinal surgery reduces the future risk of falling. Level of Evidence: Therapeutic Level II. Retrospective analysis of prospectively collected data. See Instructions for Authors for a complete description of levels of evidence.
Full Text
http://jbjs.org/content/96/13/e110.long
DOI
10.2106/JBJS.M.00427
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Tae Hwan(김태환)
Kim, Hak Sun(김학선) ORCID logo https://orcid.org/0000-0002-8330-4688
Kim, Ho Joong(김호중)
Moon, Seong Hwan(문성환)
Park, Moon Soo(박문수)
Park, Jin Oh(박진오)
Lee, Byung Ho(이병호) ORCID logo https://orcid.org/0000-0001-7235-4981
Lee, Hwan Mo(이환모) ORCID logo https://orcid.org/0000-0002-5405-3832
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/99752
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