Discectomia lombare: valutazione e comparazione degli effetti acuti degli esercizi del core, con stabilometria e sensore inerziale o specchio, sull’allineamento spinale e l’equilibrio. Studio Pilota

Lumbar discectomy: evaluation and comparison of the acute effects of core exercises, done using stabilometric platform and inertial sensor or mirror, on spine alignment and balance. Pilot study.

Autori

Marin Luca (Laboratory of Adapted Motor Activity (LAMA), University of Pavia, Pavia, Italy), (Department of Rehabilitation, Healthcare Institute “Città di Pavia”, Gruppo San Donato, Pavia, Italy), (Department of Rehabilitation, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic)

Chiodaroli Matteo (Department of Rehabilitation, Healthcare Institute “Città di Pavia”, Gruppo San Donato, Pavia, Italy), (Laboratory for Rehabilitation, Medicine and Sport (LARMS), Rome, Italy)

Gatti Alessandro (Laboratory of Adapted Motor Activity (LAMA), University of Pavia, Pavia, Italy)

Carlone Nicolò (Degree Course in Physiotherapy, University of Pavia, Pavia, Italy), (Department of Rehabilitation, Healthcare Institute “Città di Pavia”, Gruppo San Donato, Pavia, Italy)

Manzoni Federica (S.C. Epidemiology, Health Protection Agency of Pavia, Pavia, Italy)

Re Fabio (Laboratory for Rehabilitation, Medicine and Sport (LARMS), Rome, Italy)

Patanè Pamela (Laboratory of Adapted Motor Activity (LAMA), University of Pavia, Pavia, Italy), (Laboratory for Rehabilitation, Medicine and Sport (LARMS), Rome, Italy), (Department of Industrial Engineering, University of Tor Vergata, Rome, Italy)

Abbiati Fabrizio (Department of Rehabilitation, Healthcare Institute “Città di Pavia”, Gruppo San Donato, Pavia, Italy), (Laboratory for Rehabilitation, Medicine and Sport (LARMS), Rome, Italy)

Febbi Massimiliano (Department of Rehabilitation, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic), (Laboratory for Rehabilitation, Medicine and Sport (LARMS), Rome, Italy)

Introduction

Conservative therapy is usually the first choice for spine disc herniation and most of patients benefit from this treatment. Microscopic lumbar discectomy (MLD) is often the best alternative when conservative therapy fails. However, in the early days post-MLD many patients show functional impairments and kinesiophobia that are associated with worse clinical outcomes.

Spinal proprioception is crucial but patients tend to use more signals coming from the ankle. Lower levels of spinal proprioception and balance lead to sensorimotor alterations and impaired motor control which are both risk factors for postural alterations, trauma and pain.

Therefore, immediately encouraging patients to be active and do core activation exercises is essential. Aim of the study is to evaluate the acute effects of two different physiotherapic methods, both involving core perception and activation, on balance and spine alignment in patients that underwent MLD.

Methods

From 20^th June to 28^th July 2023, 12 patients (6 female) candidates for MLD, were recruited. After signing an informed consent they were randomly assigned to one of the two Core activation exercises study group: Visual biofeedback, with stabilometric platform and inertial sensor (BF) (Riablo, Euleria, Rovereto, Italy) or squared up mirror (ES).

Both interventions lasted 10 minutes and included the same exercises, supervised by Physiotherapist. Before (T0) and after (T1) the intervention an assessment was made. Spine alignment (RMS) was evaluated with Spine 3D (Sensormedica, Guidonia, Rome), a non-invasive, three-dimensional optoelectronic detection system that uses Light Detection and Ranging technology, while balance with a stabilometric platform (FreeMed, sensormedica). In T0, participants were asked to assume the most comfortable position. In T1, they were asked to assume the most correct posture possible, using the sensorimotor information learned with the intervention.

Results

The Bruschen-Pagan test was used to determine whether the model was parametric or not. To compare improvement between groups, while controlling for baseline levels, we used analysis of covariance (ANCOVA). Quantitative variables are expressed as mean and standard deviation. The significance was set at p<0.05. All analyses were performed using R Statistical Software (v4.1.2; R Core Team 2021).

In T1, compared to T0, all balance parameters improve slightly in BF and worsen in ES; all values aren’t significant.

Ellipse Area: BF (133.61±76.66; 216.16±229.78), ES (157.39±93.91; 143.72±67.63) p 0.091. Ellipse Eccentricity: BF (0.32±0.22; 0.25±0.24), ES (0.50±0.39; 0.59±0.18) p 0.53. Delta X: BF (12.90±4.92; 13.41±6.19), ES (16.47±9.00; 13.75±5.08) p 0.342. Delta Y: BF (11.33±3.72; 13.76±6.30), ES (13.42±2.42; 12.31±4.88) p 0.083. RMS improves in BF (5.17±3.31; 6.00±3.31) while it worsens in ES (3.50±1.38; 3.31±2.04); both values aren’t significant.

Discussion and Conclusion

It is known that immediately after spine surgery the perceptual-motor adaptation mechanisms are reduced or absent. In addition a postural correction, greater than the usual one causes difficulties to somato-sensory system to adapt to the new position. A previous study, done on the same population and with the same methodology but without the biofeedback provided by stabilometry, had shown a worsening of balance in both groups, greater in the group that had an improvement in RMS. The acute improvements of balance and spine alignment in BF compared to ES seem to indicate that the biofeedback given by the technology is useful to improve posture and balance of patients undergoing MLD. Limitations of the study are the small number of the sample and the single session of exercises, justified by the reduced post-MLD hospitalization time. Further studies, with a significant sample size and more sessions, are needed.

REFERENCES

1) Chen B-L, Guo J-B, Zhang H-W, et al. Surgical versus non-operative treatment for lumbar disc herniation: a systematic review and meta-analysis. Clinical Rehabilitation. 2018;32(2):146-160.

2) Gilmore, S. J., Hahne, A. J., Davidson, M., McClelland, J. A. (2020). Physical activity patterns of patients immediately after lumbar surgery. Disability and rehabilitation, 42(26), 3793–3799.

3) Hebert, J. J., Fritz, J. M., Thackeray, A., Koppenhaver, S. L., & Teyhen, D. (2015). Early multimodal rehabilitation following lumbar disc surgery: a randomised clinical trial comparing the effects of two exercise programmes on clinical outcome and lumbar multifidus muscle function. British journal of sports medicine, 49(2), 100–106.

Lumbar interbody arthrodesis: acute effects of perception and Core activation exercises on balance and spine alignment. Pilot study.

Introduction

Lumbar spondylolisthesis is a pathological condition of the spine characterized by the slipping of one vertebra compared with the underlying one. According to Meyer, severity is classified considering the degree of slip. For low-grades, the first line of treatment is conservative therapy, including: activity modification, bracing, back muscles strengthening exercises, and back brace. If these treatments fail, next treatment option is lumbar interbody fusion surgery (LIF). Following LIF, trunk proprioception, essential for static and dynamic balance, may decrease favoring sensorimotor and movement control alterations. Thus, providing information to the somatosensory system through guided exercises is important. The aim of the study was to evaluate the acute effects of perception and core activation exercises on balance and spine alignment in people undergoing LIF.

Methods

From 20^th June to 30^th September 2022, 20 patients candidates for LIF, were recruited. After signing an informed consent they were randomly assigned to one of the two study groups: Guided Core Activation and Perception Exercises (GE), or Autonomous Self-Correction (GC). Both interventions lasted 10 minutes and were carried out in front of a squared up mirror. Three evaluations were made: before LIF (PRE) and on third day after LIF, before (P1) and after (P2) the intervention assigned to the group. In PRE and P1 participants were asked to assume the most comfortable position. In P2 they were asked to assume the most correct posture possible, using the information learned. Spine alignment (RMS) was evaluated with Spine 3D (Sensormedica, Guidonia, Rome), a non-invasive, three-dimensional optoelectronic detection system that uses Light Detection and Ranging technology, while balance with a stabilometric platform (FreeMed, sensormedica).

Results

Data were processed with Jamovi for Mac version 1.6. Quantitative variables are expressed as mean and standard deviation. Normality of data was calculated with Shapiro Wilk’s test. The difference between the variables over time in the two groups was calculated with ANOVA for repeated measures. The significance was set at p<0.05. In P1, compared to PRE, all investigated parameters worsen, non-significantly, in both groups. In P2, compared to P1, all balance parameters worsen significantly in both groups, some more in GE than in GC. Ellipse Area: GE (158.71±120.08; 83.44±102.2), GC (175.11±133.92; 158.54±139.46) p 0.001. Ellipse Eccentricity: GE (0.64±0.33; 0.48±0.29), GC (0.54±0.15; 0.44±0.2) p 0.018. Delta X: GE (11.37±4.23; 9.73±4.88), GC (18.82±10.85; 15.74±9.77) p 0.001. Delta Y: GE (11.18±6.52; 7.46±4.29), GC (16.97±8.52; 13.41±9.36) p 0.001. RMS improves in GE (3.1±1.85; 4.4±2.41) while it worsens in GC (4.9±0.99; 3.8±1.75); both values are not significant.

Discussion and Conclusion

Comparing PRE and P1, the worsening of balance parameters is referable to the postoperative sequelae of LIF. It is known that immediately after surgery the perceptual-motor adaptation mechanisms are reduced or absent. In P2 compared to P1, the slight improvement in RMS of GE compared to the worsening of GC is probably due to the exercises performed with the Physiotherapist. Likewise, the greater deterioration of the balance of GE compared to GC is in agreement with the literature. This highlights how, in acute phase, a postural correction greater than the usual one, leads a difficulty of the somato-sensory system to adapt to the new position. Limitations of the study are the small number of the sample and the single session of exercises, justified by the reduced post-LIF hospitalization time. Further studies, with a significant sample size and over time, are needed.

REFERENCES

1) Hebert, J. J., Fritz, J. M., Thackeray, A., Koppenhaver, S. L., &amp; Teyhen, D. (2015). Early
multimodal rehabilitation following lumbar disc surgery: a randomised clinical trial comparing
the effects of two exercise programmes on clinical outcome and lumbar multifidus muscle
function. British journal of sports medicine, 49(2), 100–106.
2) Gilmore, S. J., Hahne, A. J., Davidson, M., &amp; McClelland, J. A. (2020). Physical activity
patterns of patients immediately after lumbar surgery. Disability and rehabilitation, 42(26),
3793–3799.
3) Janssens, L., Brumagne, S., Claeys, K., Pijnenburg, M., Goossens, N., Rummens, S., &amp;
Depreitere, B. (2016). Proprioceptive use and sit-to-stand-to-sit after lumbar microdiscectomy:
The effect of surgical approach and early physiotherapy. Clinical biomechanics (Bristol,
Avon), 32, 40–48.