Neuromodulation : journal of the International Neuromodulation Society · 2025
Relationship of Gait and Balance to Successful Spinal Cord Stimulation Trials in Patients Being Treated for Persistent Spinal Pain Syndrome Type 2.
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Wilson Bethany A, Mar Damon, Robinson Kyle T, Ohnmeiss Donna D, McMahan Sara, Rashbaum Ralph F
Аннотация
BACKGROUND: Persistent spinal pain syndrome type 2 (PSPS2) is characterized by chronic pain after spine surgery, with spinal cord stimulation (SCS) being a common treatment when conservative measures fail. SCS modulates pain and improves functional outcomes, but approximately 40% of patients receiving an SCS trial do not experience adequate relief. Most SCS studies depend on patient-reported measures, necessitating incorporation of objective assessments.
OBJECTIVE: This study aimed to investigate differences in functional gait and balance outcomes between patients in whom SCS trial succeeds and those in whom it fails.
MATERIALS AND METHODS: This prospective cohort study included 23 patients with PSPS2 who underwent SCS trials, classified as "pass" (≥50% pain relief; n = 15) or "fail" (<50% pain relief; n = 8) on the basis of trial results. The patients completed baseline patient-reported outcome measures (PROMs) for pain and disability and performed gait and balance tasks before their SCS trial. Gait spatiotemporal parameters, gait kinematics, and standing balance sway were collected using a Vicon motion capture system and AMTI force plates. Group comparisons of PROMs and functional metrics were conducted, with significance set at p < 0.05.
RESULTS: Pass and fail groups were similar in demographic characteristics and PROMs. Spatiotemporal and standing balance measures were not significantly different. The fail group showed significantly reduced hip adduction and external rotation during walking. Torso and pelvis movement did not differ significantly; however, the fail group displayed greater upper torso lateral shifting during walking.
CONCLUSIONS: Spatiotemporal and standing balance measures did not differ between SCS trial outcome groups. Kinematics suggest that hip range of motion (ROM) may be related to SCS trial outcomes. A combination of increased lateral hip ROM and elevated lateral torso sway suggests enhanced lumbar stabilization and pain-avoidant behaviors. Underlying hip pathology should be considered to exclude other potential causes of pain. Understanding these compensatory mechanisms is crucial, given they may indicate dynamic pain that could decrease the effectiveness of SCS.
OBJECTIVE: This study aimed to investigate differences in functional gait and balance outcomes between patients in whom SCS trial succeeds and those in whom it fails.
MATERIALS AND METHODS: This prospective cohort study included 23 patients with PSPS2 who underwent SCS trials, classified as "pass" (≥50% pain relief; n = 15) or "fail" (<50% pain relief; n = 8) on the basis of trial results. The patients completed baseline patient-reported outcome measures (PROMs) for pain and disability and performed gait and balance tasks before their SCS trial. Gait spatiotemporal parameters, gait kinematics, and standing balance sway were collected using a Vicon motion capture system and AMTI force plates. Group comparisons of PROMs and functional metrics were conducted, with significance set at p < 0.05.
RESULTS: Pass and fail groups were similar in demographic characteristics and PROMs. Spatiotemporal and standing balance measures were not significantly different. The fail group showed significantly reduced hip adduction and external rotation during walking. Torso and pelvis movement did not differ significantly; however, the fail group displayed greater upper torso lateral shifting during walking.
CONCLUSIONS: Spatiotemporal and standing balance measures did not differ between SCS trial outcome groups. Kinematics suggest that hip range of motion (ROM) may be related to SCS trial outcomes. A combination of increased lateral hip ROM and elevated lateral torso sway suggests enhanced lumbar stabilization and pain-avoidant behaviors. Underlying hip pathology should be considered to exclude other potential causes of pain. Understanding these compensatory mechanisms is crucial, given they may indicate dynamic pain that could decrease the effectiveness of SCS.