Differentiated diagnostic approaches for gait disorders associated with back pain (scientific review)

Authors:

Yastrebtseva Irina Petrovna — Grand PhD in Medical Sciences (Dr. Med. Sci.), Associate Professor, professor at the Department of Neurology and Neurosurgery Ivanovo State Medical Academy, 8 Sheremetyevo Avenue, 153012 Ivanovo, Russian Federation; professor at the department of medical rehabilitation, faculty of additional professional education, institute of continuing education and professional development of The Russian National Research Medical University named after N.I. Pirogov, 1 Ostrovityanova Street, 117997 Moscow, Russian Federation; e-mail: ip.2007@mail.ru.

Shmonin Alexey Andreevich — Grand PhD in Medical Sciences (Dr. Med. Sci.), Associate Professor at the Department of Pathophysiology with a course in clinical Pathophysiology, I.P. Pavlov First St. Petersburg State Medical University. 6-8 Lva Tolstogo Street, 197022, St. Petersburg, Russian Federation; professor at the Department of Hospital Therapy, Ivanovo State Medical Academy, 8 Sheremetyevo Avenue, 153012 Ivanovo, Russian Federation; e-mail: langendorff@mail.ru.

Aleksinsky Dmitry Sergeevich — student, Ivanovo State Medical Academy, 8 Sheremetyevo Avenue, 153012 Ivanovo, Russian Federation; e-mail: jester.97.97@mail.ru.

Saraeva Valeria Sergeevna — student of Ivanovo State Medical Academy, 8 Sheremetyevo Avenue, 153012 Ivanovo, Russian Federation; e-mail: v.saraeva@mail.ru.

Annotation:

Introduction. Back pain is accompanied by functional disorders and limitations in everyday activity of sick people and it requires a differentiated and comprehensive approach to diagnostic.

Aim. The object of this article was to analyze the scientific literature to determine diagnostic criteria for gait disorders associated with back pain in patients with vertebral degenerative-dystrophic diseases.

Materials and methods. The search for relevant publications was carried out using the databases “Cochrane Library”, “eLIBRARY.RU”, “PubMed”, “Google academy”, “MedLine”, ”EBSCO”, ”Scopus”, ”Web of Science”, ”PEDro”, ”CINAHL”, ”Eric”, “Springer/nature”, “Elsevier”. The review included 22 works (systematic reviews, meta-analyses, randomized controlled trials) regarding the diagnosis of back pain in patients with vertebral pathology.

Results. Based on advanced data analytics from 13 scientific databases were identified variants of changes in gait caused by sensory and motor clinical manifestations associated with back pain. Various specific disease forms with lesions the spine can lead to characteristic changes in the gait pattern. Muscle involvement due to radicular damage is reflected in gait characteristics. Emphasis is placed on lumbar motor control to promote stability of the lumbar spine and coordination between the rib cage and pelvis. The importance of simple visual assessment in the diagnosis of walking disorders is shown.

Summary. Back pain in patients with vertebral degenerative-dystrophic diseases might be accompanied by gait disorders with the development of a gentle gait, foot drop gait, uncoordinated gait, and neurogenic lameness. Scoliosis, osteoporosis with compression fractures, and spondylolisthesis can affect people’s gait.

List of cited literature:

1. Aleena AT, Eslavath R, Romate J, Allen JG. Determinants of quality of life in individuals with chronic low back pain: a systematic review. Health Psychology and Behavioral Medicine. 2022;10(1):124-44. DOI: 10.1080/21642850.2021.2022487.

2. Errabity A, Calmels P, Han WS, Bonnaire R, et al. The effect of low back pain on spine kinematics: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon). 2023;108:106070. DOI: 10.1016/j.clinbiomech.2023.106070.

3. Smith JA, Stabbert H, Bagwell JJ, Teng HL, et al. Do people with low back pain walk differently? A systematic review and meta-analysis. J Sport Health Sci. 2022;11(4):450-465. DOI: 10.1016/j.jshs.2022.02.001.

4. Hayden JA, Ellis J, Ogilvie R, Malmivaara A, et al. Exercise therapy for chronic low back pain (Review). Cochrane Database of Systematic Reviews. 2021;9(9):1-553. DOI: 10.1002/14651858.CD009790.pub2

5. Ryavkin SY, Ponomarenko GN, Drobyshev VA, Shashukov DA, et al. Effektivnost’ primeneniya chrezkozhnoj elektronejrostimulyacii pri diskogennyh dorsopatiyah poyasnichnoj lokalizacii [The effectiveness of transcutaneous electrical nerve stimulation in discogenic dorsopathies of the lumbar localization]. Vestnik vosstanovitel’noj mediciny [Bulletin of Rehabilitation Medicine]. 2012;11(5):1-8. (In Russian).

6. Marks VO. Ortopedicheskaya diagnostika [Orthopedic diagnostics (reference manual)]. Moskva: Izd-vo «Nauka i tekhnika» [Moscow: Publishing house “Science and technology”], 1978. 99 p. (In Russian).

7. Pirker W, Katzenschlager R. Gait disorders in adults and the elderly: A clinical guide. Wien Klin Wochenschr. 2017;129:81-95. DOI: 10.1007/s00508-016-1096-4.

8. Liyew WA. Clinical Presentations of Lumbar Disc Degeneration and Lumbosacral Nerve Lesions. Intermational journey of Rheumatology. 2020;2020:1-13. DOI: 10.1155/2020/2919625.

9. Oichi T, Taniguchi Y, Oshima Y, Tanaka S, et al. Pathomechanism of intervertebral disc degeneration. JOR Spine. 2020;3(1):e1076. DOI: 10.1002/jsp2.1076.

10. Talanov AB, Gogolev AY, Balandin NA. Kliniko-hirurgicheskie osobennosti degenerativnyh porazhenij poyasnichnogo otdela pozvonochnika u bol’nyh molodogo vozrasta [Clinical and surgical features of degenerative lesions of the lumbar spine in young patients]. Vestnik Ivanovskoj medicinskoj akademii [Bulletin of the Ivanovo MedicalAcademy]. 2022;27(2):31-7. DOI: 10.52246/1606-8157_2022_27_2_31. (In Russian).

11. Smith JA, Stabbert H, Bagwell JJ, Teng HL, et al. Do people with low back pain walk differently? A systematic review and meta-analysis. J Sport Health Sci. 2022;11(4):450-65. DOI: 10.1016/j.jshs.2022.02.001.

12. Cook C, Brismee JM, Sizer PS Jr. Subjective and objective descriptors of clinical lumbar spine instability: a Delphi study. Man Ther. 2006;11(1):11-21. DOI: 10.1016/j.math.2005.01.002.

13. Luomajoki H, Kool J, de Bruin ED, Airaksinen O. Reliability of movement control tests in the lumbar spine. BMC Musculoskelet Disord. 2007;8:90. DOI: 10.1186/1471-2474-8-90.

14. Unsgaard-Tondel M, Fladmark AM, Salvesen 0, Vasseljen O. Motor control exercises, sling exercises, and general exercises for patients with chronic low back pain: a randomized controlled trial with 1-year follow-up. Phys Ther. 2010;90(10):1426-40. DOI: 10.2522/ptj.20090421.

15. Labelle H, Roussouly P, Berthonnaud E, Transfeldt E, et al. Spondylolisthesis, pelvic incidence, and spinopelvic balance: a correlation study. Spine (Phila Pa 1976). 2004;29(18):2049-54. DOI: 10.1097/01.brs.0000138279.53439.cc.

16. Chuang CY, Liaw MY, Wang LY, Huang YC, et al. Spino-pelvic alignment, balance, and functional disability in patients with low-grade degenerative lumbar spondylolisthesis. J Rehabil Med. 2018;50(10):898-907. DOI: 10.2340/16501977-2489.

17. Cirillo Totera JI, Fleiderman Valenzuela JG, Garrido Arancibia JA, Pantoja Contreras ST, et al. Sagittal balance: from theory to clinical practice. EFORT Open Rev. 2021;6(12):1193-202. DOI: 10.1302/2058-5241.6.210062.

18. Radovanovic I, Urquhart JC, Rasoulinejad P, Gurr KR, et al. Patterns of C-2 fracture in the elderly: comparison of etiology, treatment, and mortality among specific fracture types. J Neurosurg Spine. 2017;27(5):494-500. DOI: 10.3171/2017.3.SPINE161176.

19. Dubousset J. Three-dimensionality in vertebral pathology: the horizontal plane is hidden in every scoliotic deformity. Spine surgery. 2021;18(2):93-103. DOI: 10.14531/ss2021.2.93-103.

20. Haddas R, Lieberman IH. A method to quantify the “cone of economy”. Eur Spine J. 2018;27(5):1178-87. DOI: 10.1007/s00586-017-5321-2.

21. Natarajan P, Fonseka RD, Kim S., Betteridge C, et al. Analysing gait patterns in degenerative lumbar spine diseases: a literature review. Journal of spine surgery. 2022;8:139-48. DOI: 10.21037/jss-21-91.

22. Jacobs E, McCrum C. Gait in patients with symptomatic osteoporotic vertebral compression fractures over 6 months of recovery. Springer. 2019;9:239-46. DOI: 10.1007/s40520-019-01203-9.