Postural Stability in Patient with Chronic Low Back Pain after Lumbar Surgery: A Long Term Follow-Up Study

慢性下背痛病人接受腰椎手術後姿勢穩定表現：長期追蹤研究

林昱瑄(Iu-Shiuan Lin) ； 賴達明(Dar-Ming Lai) ； 劉沛怡(Phooi Yee Lau) ； 徐瑋勵(Wei-Li Hsu)

《物理治療》 42卷2期 (2017/06) Pp. 179-180

https://doi.org/10.6215/FJPT.2017.73.P35

摘要

Background and Purpose: Misalignment of lumbar spine may cause chronic low back pain and influence patient's living activity. In addition, the sensation and proprioception input may be altered, leading impaired balance performance. Surgical management is a direct method to relieve pain by adjusting the spinal alignment. However, whether the lumbar surgery improves the postural function and it's long term effect are still uncertain. The purpose of this study is to evaluate the long term effect on postural steadiness of patients with chronic low back pain after lumbar surgery. Methods: Thirty-three participants with chronic low back pain were recruited from National Taiwan University Hospital. All participants had lumbar surgery operated by the same surgeon and were assessed at the following four time points: before surgery (baseline), 3 months, 6 months, and 12 months after surgery. All participants were instructed standing with feet shoulder-width apart (OE) and in Romberg stance (RSOE) respectively on a force platform for 35 seconds. The trials were recorded by a LabView program and the sway area of center of pressure (COP) of each trial was calculated. The changes of sway area at four time points of the two conditions were analyzed by Wilcoxon signed rank test. Significance level was set at 0.05. Results: In natural standing, the sway area of the COP significantly increased at 3-months follow-up and 6-months respectively (p = 0.011; p = 0.021) when compared to the baseline, and significantly decreased at 12-months when compared to those at 6-months (p = 0.011). However, no significant difference between baseline and 12-months follow-up (p = 0.304). In Romberg stance, the sway area of the COP at 3-months and 6-months were significantly higher than the baseline respectively (p = 0.036, p = 0.034). However, no significant difference was found between the baseline and 12-months follow-up (p = 0.406). Conclusion: After lumbar surgery, the postural stability may decrease due to the change of the spinal alignment at the first 6 months. However, after 12 months post-surgery, the postural stability may improve, but no significant difference when compared to the performance before surgery. Clinical Relevance: The result of this study suggests that the postural stability may decline at the first 6 months after lumbar surgery and recover to baseline after one year. Therefore, early rehabilitation in balance training and postural correction for patients with lumbar surgery should be considered.