INVESTIGATION INTO THE MECHANISM OF SYMPTOM RELIEF WITH FORWARD FLEXION IN OLDER

椎管狭窄在老年人中是一种常见的脊椎疾病，在老年人中通常会导致活动障碍和残疾。导致椎管狭窄患者症状的生物力学异常很难理解。静态的椎管直径不能很好地预测症状，而且与手术减压的反应并不一致。目前的治疗选择包括物理治疗、药物治疗、注射和手术。腰椎手术是65岁以上患者最常见的主要手术之一。使用这种不准确的静态成像来诊断和指导治疗可能会导致不必要的手术，并伴随着相关的发病率和死亡率。与静态成像相比，更准确的前屈可能会导致有利的脊柱解剖变化，从而促进症状改善。支持这一推测的证据是，与平板跑步机相比，椎管狭窄症患者在倾斜的跑步机上能够在症状出现之前走得更长，这有助于前屈。在这项先导性研究中需要解决的关键知识差距是，更好地理解前屈步行延迟症状出现的临床观察背后的动态脊柱机制。对体内脊柱动力学的洞察有助于为未来的康复和手术干预提供信息。 在这项试验中收集的数据，以及来自母公司研究的数据，将被用作一项临床试验的初步数据，以检验基于屈曲的锻炼计划在椎管狭窄患者中的有效性，并检查这种改善的运动学机制。这些发现还可以用来计划一项观察性研究，即倾斜行走时直径变化的能力，以预测手术反应。因此，这一试点项目代表着支持未来研究的初步工作，这些研究将具有强大的临床翻译潜力。

Spinal stenosis is a frequently encoimtered spinal condition in the elderlyS and commonly leads to mobility impairment and disability in older adults. The biomechanical abnormalities leading to symptoms in patients with spinal stenosis are poorly imderstood. Static canal diameter is a poor predictor of symptoms^ and does not consistently correlate with response to surgical decompression.3-6. Current treatment options include physical therapy, medications, injections, and surgery. Lumbar spine surgery is among the most common major procedures for patients over the age of 65. The use of such inaccurate static imaging to diagnose and guide treatment likely leads to unnecessary procedures with associated morbidity and mortality. In contrast to static imaging, a more accurate that forward flexion might induce advantageous spinal anatomic changes that facilitate symptom improvement. Evidence to support this conjecture is that patients with spinal stenosis are able to walk longer before onset of symptoms on an inclined treadmill, which facilitates forward flexion, compared to a flat treadmill.^ The key gap in knowledge to be addressed in this pilot study is a better imderstanding of the dynamic spinal mechanism underlying the clinical observation of delayed onset of symptoms with forward flexed walking. Insights into in vivo spinal dynamics can help inform future interventions, both rehabilitative and surgical. The data collected in this pilot, in combination with data from the parent study, will be used as preliminary data in a proposal for a clinical trial to examine the effectiveness of a flexion based exercise program in patients with spinal stenosis and to examine kinematic mechanisms of this improvement. These findings can also be used to plan an observational study of the ability of diameter change with inclined walking to predict surgical response. This pilot project therefore represents the initial work to support future studies which will have strong potential for clinical translation.