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

椎管狭窄是老年人常见的脊柱疾病，通常会导致老年人的活动障碍和残疾。导致椎管狭窄症患者症状的生物力学异常尚不清楚。静态椎管直径是一个不良的症状预测因子，并且与手术减压的反应并不一致。目前的治疗方案包括物理治疗、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导致不必要的手术，并导致相关的发病率和死亡率。与静态成像相比， 前屈可能引起有利于症状改善的脊柱解剖学变化。支持这一推测的证据是，与平板跑步机相比，椎管狭窄患者在症状发作前能够在倾斜跑步机上行走更长时间，这有助于向前弯曲。在这项初步研究中要解决的关键知识差距是更好地理解脊柱动力学机制，这是前屈行走症状延迟发作的临床观察的基础。对体内脊柱动力学的了解可以帮助为未来的干预提供信息，包括康复和手术。 本试验中收集的数据与母研究的数据相结合，将用作临床试验提案的初步数据，以检查椎管狭窄患者屈曲运动计划的有效性，并检查这种改善的运动学机制。这些发现也可用于计划一项观察性研究，研究倾斜行走时直径变化预测手术反应的能力。因此，该试点项目代表了支持未来研究的初步工作，这些研究将具有很强的临床转化潜力。

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.