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Gender Differences in Balance, Lumbar Multifidus Muscle, Pain, and Kinesiophobia in Patients with Lumbar Spinal Stenosis

Yıl 2024, Cilt: 26 Sayı: 1, 28 - 33, 30.04.2024

Aydın Sinan Apaydın Musa Güneş Nevin Köremezli Keskin

https://doi.org/10.18678/dtfd.1374498

Öz

Aim: The aim of this study was to examine balance, lumbar multifidus muscle thickness and cross-sectional area (CSA), pain, disability and kinesiophobia levels, and to compare these parameters in terms of gender in patients with lumbar spinal stenosis (LSS).
Material and Methods: This cross-sectional study included 59 patients, 33 (55.9%) female and 26 (44.1%) male, diagnosed with LSS by magnetic resonance imaging (MRI). Low back and leg pains, dynamic and static balances, disability and kinesiophobia levels of patients with LSS were evaluated. Lumbar multifidus muscle thickness and total CSA were obtained from MRI images. Obtained data were compared according to gender.
Results: Females had significantly more low back pain than males (p=0.043), in patients with LSS. Additionally, females with LSS had worse dynamic and static balances (p=0.005, and p=0.001, respectively) and higher levels of disability (p=0.001), and kinesiophobia (p=0.001). Females with LSS had less lumbar multifidus muscle thickness and CSA than males on both the right and left sides. Also, right multifidus muscle thickness correlated with both dynamic (r=-0.289; p=0.027) and static (r=0.349; p=0.007) balances. Significant correlations were detected between low back and leg pain with dynamic and static balances, disability, and kinesiophobia in patients with LSS.
Conclusion: Females with LSS have higher levels of pain, disability, and kinesiophobia than males. Also, LSS affects females' balance functions more and causes further degeneration of the multifidus muscle. Therefore, gender differences should be examined during the clinical follow-up process in LSS.

Anahtar Kelimeler

Lumbar spinal stenosis gender differences multifidius balance pain kinesiophobia

Kaynakça

  • Genevay S, Atlas SJ. Lumbar spinal stenosis. Best Pract Res Clin Rheumatol. 2010;4(2):253-65.
  • Lee BH, Moon SH, Suk KS, Kim HS, Yang JH, Lee HM. Lumbar spinal stenosis: pathophysiology and treatment principle: a narrative review. Asian Spine J. 2020;14(5):682-93.
  • Kalichman L, Cole R, Kim DH, Li L, Suri P, Guermazi A, et al. Spinal stenosis prevalence and association with symptoms: the Framingham study. Spine J. 2009;9(7):545-50.
  • Kim HJ, Suh BG, Lee DB, Park JY, Kang KT, Chang BS, et al. Gender difference of symptom severity in lumbar spinal stenosis: role of pain sensitivity. Pain Physician. 2013;16(6):E715-23.
  • Farrokhi MR, Haghnegahdar A, Rezaee H, Sharifi Rad MR. Spinal sagittal balance and spinopelvic parameters in patients with degenerative lumbar spinal stenosis; a comparative study. Clin Neurol Neurosurg. 2016;151:136‐41.
  • Thornes E, Robinson HS, Vøllestad NK. Dynamic balance in patients with degenerative lumbar spinal stenosis; a cross-sectional study. BMC Musculoskelet Disord. 2018;19(1):192.
  • Truszczyńska A, Drzał-Grabiec J, Trzaskoma Z, Rąpała K, Tarnowski A, Górniak K. A comparative analysis of static balance between patients with lumbar spinal canal stenosis and asymptomatic participants. J Manipulative Physiol Ther. 2014;37(9):696‐701.
  • Karagül S, Kartaloğlu IF. The effect of single and dual-task balance exercises on balance performance in older adult patients with degenerative lumbar spinal stenosis: A randomized controlled trial. Geriatr Nurs. 2023;49:133-8.
  • Farshad M, Gerber C, Farshad-Amacker NA, Dietrich TJ, Laufer-Molnar V, Min K. Asymmetry of the multifidus muscle in lumbar radicular nerve compression. Skeletal Radiol. 2014;43(1):49-53.
  • Chua M, Hochberg U, Regev G, Ophir D, Salame K, Lidar Z, et al. Gender differences in multifidus fatty infiltration, sarcopenia and association with preoperative pain and functional disability in patients with lumbar spinal stenosis. Spine J. 2022;22(1):58-63.
  • Fortin M, Lazáry À, Varga PP, Battié MC. Association between paraspinal muscle morphology, clinical symptoms, and functional status in patients with lumbar spinal stenosis. Eur Spine J. 2017;26(10):2543-51.
  • Sions JM, Elliott JM, Pohlig RT, Hicks GE. Trunk muscle characteristics of the multifidi, erector spinae, psoas, and quadratus lumborum in older adults with and without chronic low back pain. J Orthop Sports Phys Ther. 2017;47(3):173-9.
  • Wang H, Zheng J, Fan Z, Luo Z, Wu Y, Cheng X, et al. Impaired static postural control correlates to the contraction ability of trunk muscle in young adults with chronic non-specific low back pain: A cross-sectional study. Gait Posture. 2022;92:44-50.
  • Hiyama A, Katoh H, Sakai D, Tanaka M, Sato M, Watanabe M. The correlation analysis between sagittal alignment and cross-sectional area of paraspinal muscle in patients with lumbar spinal stenosis and degenerative spondylolisthesis. BMC Musculoskelet Disord. 2019;20(1):352.
  • Güneş M, Özmen T, Güler TM. The association between pain, balance, fall, and disability in patients with lumbar spinal stenosis with vascular claudication. Korean J Pain. 2021;34(4):471-8.
  • Patel DV, Yoo JS, Karmarkar SS, Lamoutte EH, Singh K. Sex differences on postoperative pain and disability following minimally invasive lumbar discectomy. Clin Spine Surg. 2019;32(10):E444-8.
  • van Wilgen CP, Stewart R, Patrick Stegeman PT, Coppes M, van Wijhe M. Fear of movement in pre-operative patients with a lumbar stenosis and or herniated disc: factor structure of the Tampa scale for kinesiophobia. Man Ther. 2010;15(6):593-8.
  • Ozcan Kahraman B, Kahraman T, Kalemci O, Salik Sengul Y. Gender differences in postural control in people with nonspecific chronic low back pain. Gait Posture. 2018;64:147-51.
  • Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62(3):363-72.
  • Wang W, Sun Z, Li W, Chen Z. The effect of paraspinal muscle on functional status and recovery in patients with lumbar spinal stenosis. J Orthop Surg Res. 2020;15(1):235.
  • Rezazadeh F, Taheri N, Okhravi SM, Hosseini SM. The relationship between cross-sectional area of multifidus muscle and disability index in patients with chronic non-specific low back pain. Musculoskelet Sci Pract. 2019;42:1-5.
  • Hu ZJ, He J, Zhao FD, Fang XQ, Zhou LN, Fan SW. An assessment of the intra- and inter-reliability of the lumbar paraspinal muscle parameters using CT scan and magnetic resonance imaging. Spine (Phila Pa 1976). 2011;36(13):E868-74.
  • Lin SI, Lin RM. Disability and walking capacity in patients with lumbar spinal stenosis: association with sensorimotor function, balance, and functional performance. J Orthop Sports Phys Ther. 2005;35(4):220‐6.
  • Kim HJ, Chun HJ, Han CD, Moon SH, Kang KT, Kim HS, et al. The risk assessment of a fall in patients with lumbar spinal stenosis. Spine (Phila Pa 1976). 2011;36(9):E588-92.
  • Yakut E, Düger T, Oksüz C, Yörükan S, Ureten K, Turan D, et al. Validation of the Turkish version of the Oswestry disability index for patients with low back pain. Spine (Phila Pa 1976). 2004;29(5):581-5.
  • Schober P, Boer C, Schwarte LA. Correlation coefficients: appropriate use and interpretation. Anesth Analg. 2018;126(5):1763-8.
  • Samulowitz A, Gremyr I, Eriksson E, Hensing G. "Brave men" and "emotional women": A theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain. Pain Res Manag. 2018;2018:6358624.
  • Kobayashi Y, Ogura Y, Kitagawa T, Yonezawa Y, Takahashi Y, Yasuda A, et al. Gender differences in pre- and postoperative health-related quality of life measures in patients who have had decompression surgery for lumbar spinal stenosis. Asian Spine J. 2020;14(2):238-44.
  • Naghdi N, Mohseni-Bandpei MA, Taghipour M, Rahmani N. Lumbar multifidus muscle morphology changes in patient with different degrees of lumbar disc herniation: an ultrasonographic study. Medicina (Kaunas). 2021;57(7):699.
  • Breton É, Beloin F, Fortin C, Martin A, Ouellet MÈ, Payette H, et al. Gender-specific associations between functional autonomy and physical capacities in independent older adults: results from the NuAge study. Arch Gerontol Geriatr. 2014;58(1):56-62.
  • Sung PS, Ham YW. Comparing postural strategy changes following adapted versus non-adapted responses in subjects with and without spinal stenosis. Man Ther. 2010;15(3):261-6.
  • Ploumis A, Michailidis N, Christodoulou P, Kalaitzoglou I, Gouvas G, Beris A. Ipsilateral atrophy of paraspinal and psoas muscle in unilateral back pain patients with monosegmental degenerative disc disease. Br J Radiol. 2011;84(1004):709-13.
  • Rovner GS, Sunnerhagen KS, Björkdahl A, Gerdle B, Börsbo B, Johansson F, et al. Chronic pain and sex-differences; women accept and move, while men feel blue. PLoS One. 2017;12(4):e0175737.

Lomber Spinal Stenozlu Hastalarda Denge, Lomber Multifidus Kası, Ağrı ve Kinezyofobide Cinsiyet Farklılıkları

Yıl 2024, Cilt: 26 Sayı: 1, 28 - 33, 30.04.2024

Aydın Sinan Apaydın Musa Güneş Nevin Köremezli Keskin

https://doi.org/10.18678/dtfd.1374498

Öz

Amaç: Bu çalışmanın amacı lomber spinal stenozu (LSS) olan hastalarda denge, lomber multifidus kas kalınlığı ve kesit alanı (cross-sectional area, CSA), ağrı, sakatlık ve kinezyofobi düzeylerini incelemek ve bu parametreleri cinsiyet açısından karşılaştırmaktır.
Gereç ve Yöntemler: Bu kesitsel çalışmaya manyetik rezonans görüntüleme (MRG) ile LSS tanısı konulan 33 (%55,9) kadın ve 26 (%44,1) erkek olmak üzere 59 hasta dahil edildi. LSS'li hastaların bel ve bacak ağrıları, dinamik ve statik dengeleri, özürlülük ve kinezyofobi düzeyleri değerlendirildi. MRG görüntülerinden lomber multifidus kas kalınlığı ve toplam CSA elde edildi. Elde edilen veriler cinsiyete göre karşılaştırıldı.
Bulgular: LSS'li hastalarda, kadınlar erkeklere göre anlamlı olarak daha fazla bel ağrısına sahipti (p=0,043). Ayrıca, LSS'li kadınlarda daha kötü dinamik ve statik denge (sırasıyla p=0,005 ve p=0,001), daha yüksek düzeyde özürlülük (p=0,001) ve kinezyofobi (p=0,001) vardı. LSS'li kadınlarda hem sağ hem de sol tarafta lomber multifidus kas kalınlığı ve CSA erkeklere göre daha azdı. Ayrıca sağ multifidus kas kalınlığı hem dinamik (r=-0,289; p=0,027) hem de statik (r=0,349; p=0.007) denge ile koreleydi. LSS'li hastalarda bel ve bacak ağrısı ile dinamik ve statik dengeler, özürlülük ve kinezyofobi arasında anlamlı korelasyonlar saptandı.
Sonuç: LSS'li kadınlarda erkeklere göre daha yüksek düzeyde ağrı, özürlülük ve kinezyofobi vardır. Ayrıca LSS, kadınların denge fonksiyonlarını daha fazla etkiler ve multifidus kasının daha fazla dejenerasyonuna neden olur. Bu nedenle LSS'de klinik takip sürecinde cinsiyet farklılıkları incelenmelidir.

Anahtar Kelimeler

lomber spinal stenoz cinsiyet farklılıkları multifidus denge ağrı kinezyofobi

Kaynakça

  • Genevay S, Atlas SJ. Lumbar spinal stenosis. Best Pract Res Clin Rheumatol. 2010;4(2):253-65.
  • Lee BH, Moon SH, Suk KS, Kim HS, Yang JH, Lee HM. Lumbar spinal stenosis: pathophysiology and treatment principle: a narrative review. Asian Spine J. 2020;14(5):682-93.
  • Kalichman L, Cole R, Kim DH, Li L, Suri P, Guermazi A, et al. Spinal stenosis prevalence and association with symptoms: the Framingham study. Spine J. 2009;9(7):545-50.
  • Kim HJ, Suh BG, Lee DB, Park JY, Kang KT, Chang BS, et al. Gender difference of symptom severity in lumbar spinal stenosis: role of pain sensitivity. Pain Physician. 2013;16(6):E715-23.
  • Farrokhi MR, Haghnegahdar A, Rezaee H, Sharifi Rad MR. Spinal sagittal balance and spinopelvic parameters in patients with degenerative lumbar spinal stenosis; a comparative study. Clin Neurol Neurosurg. 2016;151:136‐41.
  • Thornes E, Robinson HS, Vøllestad NK. Dynamic balance in patients with degenerative lumbar spinal stenosis; a cross-sectional study. BMC Musculoskelet Disord. 2018;19(1):192.
  • Truszczyńska A, Drzał-Grabiec J, Trzaskoma Z, Rąpała K, Tarnowski A, Górniak K. A comparative analysis of static balance between patients with lumbar spinal canal stenosis and asymptomatic participants. J Manipulative Physiol Ther. 2014;37(9):696‐701.
  • Karagül S, Kartaloğlu IF. The effect of single and dual-task balance exercises on balance performance in older adult patients with degenerative lumbar spinal stenosis: A randomized controlled trial. Geriatr Nurs. 2023;49:133-8.
  • Farshad M, Gerber C, Farshad-Amacker NA, Dietrich TJ, Laufer-Molnar V, Min K. Asymmetry of the multifidus muscle in lumbar radicular nerve compression. Skeletal Radiol. 2014;43(1):49-53.
  • Chua M, Hochberg U, Regev G, Ophir D, Salame K, Lidar Z, et al. Gender differences in multifidus fatty infiltration, sarcopenia and association with preoperative pain and functional disability in patients with lumbar spinal stenosis. Spine J. 2022;22(1):58-63.
  • Fortin M, Lazáry À, Varga PP, Battié MC. Association between paraspinal muscle morphology, clinical symptoms, and functional status in patients with lumbar spinal stenosis. Eur Spine J. 2017;26(10):2543-51.
  • Sions JM, Elliott JM, Pohlig RT, Hicks GE. Trunk muscle characteristics of the multifidi, erector spinae, psoas, and quadratus lumborum in older adults with and without chronic low back pain. J Orthop Sports Phys Ther. 2017;47(3):173-9.
  • Wang H, Zheng J, Fan Z, Luo Z, Wu Y, Cheng X, et al. Impaired static postural control correlates to the contraction ability of trunk muscle in young adults with chronic non-specific low back pain: A cross-sectional study. Gait Posture. 2022;92:44-50.
  • Hiyama A, Katoh H, Sakai D, Tanaka M, Sato M, Watanabe M. The correlation analysis between sagittal alignment and cross-sectional area of paraspinal muscle in patients with lumbar spinal stenosis and degenerative spondylolisthesis. BMC Musculoskelet Disord. 2019;20(1):352.
  • Güneş M, Özmen T, Güler TM. The association between pain, balance, fall, and disability in patients with lumbar spinal stenosis with vascular claudication. Korean J Pain. 2021;34(4):471-8.
  • Patel DV, Yoo JS, Karmarkar SS, Lamoutte EH, Singh K. Sex differences on postoperative pain and disability following minimally invasive lumbar discectomy. Clin Spine Surg. 2019;32(10):E444-8.
  • van Wilgen CP, Stewart R, Patrick Stegeman PT, Coppes M, van Wijhe M. Fear of movement in pre-operative patients with a lumbar stenosis and or herniated disc: factor structure of the Tampa scale for kinesiophobia. Man Ther. 2010;15(6):593-8.
  • Ozcan Kahraman B, Kahraman T, Kalemci O, Salik Sengul Y. Gender differences in postural control in people with nonspecific chronic low back pain. Gait Posture. 2018;64:147-51.
  • Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62(3):363-72.
  • Wang W, Sun Z, Li W, Chen Z. The effect of paraspinal muscle on functional status and recovery in patients with lumbar spinal stenosis. J Orthop Surg Res. 2020;15(1):235.
  • Rezazadeh F, Taheri N, Okhravi SM, Hosseini SM. The relationship between cross-sectional area of multifidus muscle and disability index in patients with chronic non-specific low back pain. Musculoskelet Sci Pract. 2019;42:1-5.
  • Hu ZJ, He J, Zhao FD, Fang XQ, Zhou LN, Fan SW. An assessment of the intra- and inter-reliability of the lumbar paraspinal muscle parameters using CT scan and magnetic resonance imaging. Spine (Phila Pa 1976). 2011;36(13):E868-74.
  • Lin SI, Lin RM. Disability and walking capacity in patients with lumbar spinal stenosis: association with sensorimotor function, balance, and functional performance. J Orthop Sports Phys Ther. 2005;35(4):220‐6.
  • Kim HJ, Chun HJ, Han CD, Moon SH, Kang KT, Kim HS, et al. The risk assessment of a fall in patients with lumbar spinal stenosis. Spine (Phila Pa 1976). 2011;36(9):E588-92.
  • Yakut E, Düger T, Oksüz C, Yörükan S, Ureten K, Turan D, et al. Validation of the Turkish version of the Oswestry disability index for patients with low back pain. Spine (Phila Pa 1976). 2004;29(5):581-5.
  • Schober P, Boer C, Schwarte LA. Correlation coefficients: appropriate use and interpretation. Anesth Analg. 2018;126(5):1763-8.
  • Samulowitz A, Gremyr I, Eriksson E, Hensing G. "Brave men" and "emotional women": A theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain. Pain Res Manag. 2018;2018:6358624.
  • Kobayashi Y, Ogura Y, Kitagawa T, Yonezawa Y, Takahashi Y, Yasuda A, et al. Gender differences in pre- and postoperative health-related quality of life measures in patients who have had decompression surgery for lumbar spinal stenosis. Asian Spine J. 2020;14(2):238-44.
  • Naghdi N, Mohseni-Bandpei MA, Taghipour M, Rahmani N. Lumbar multifidus muscle morphology changes in patient with different degrees of lumbar disc herniation: an ultrasonographic study. Medicina (Kaunas). 2021;57(7):699.
  • Breton É, Beloin F, Fortin C, Martin A, Ouellet MÈ, Payette H, et al. Gender-specific associations between functional autonomy and physical capacities in independent older adults: results from the NuAge study. Arch Gerontol Geriatr. 2014;58(1):56-62.
  • Sung PS, Ham YW. Comparing postural strategy changes following adapted versus non-adapted responses in subjects with and without spinal stenosis. Man Ther. 2010;15(3):261-6.
  • Ploumis A, Michailidis N, Christodoulou P, Kalaitzoglou I, Gouvas G, Beris A. Ipsilateral atrophy of paraspinal and psoas muscle in unilateral back pain patients with monosegmental degenerative disc disease. Br J Radiol. 2011;84(1004):709-13.
  • Rovner GS, Sunnerhagen KS, Björkdahl A, Gerdle B, Börsbo B, Johansson F, et al. Chronic pain and sex-differences; women accept and move, while men feel blue. PLoS One. 2017;12(4):e0175737.
Toplam 33 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Beyin ve Sinir Cerrahisi (Nöroşirurji)
Bölüm Araştırma Makalesi
Yazarlar

Aydın Sinan Apaydın 0000-0002-2916-9550

Musa Güneş 0000-0001-8532-2575

Nevin Köremezli Keskin 0000-0002-3169-9083

Erken Görünüm Tarihi 21 Mart 2024
Yayımlanma Tarihi 30 Nisan 2024
Gönderilme Tarihi 11 Ekim 2023
Kabul Tarihi 15 Şubat 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 26 Sayı: 1

Kaynak Göster

APA Apaydın, A. S., Güneş, M., & Köremezli Keskin, N. (2024). Gender Differences in Balance, Lumbar Multifidus Muscle, Pain, and Kinesiophobia in Patients with Lumbar Spinal Stenosis. Duzce Medical Journal, 26(1), 28-33. https://doi.org/10.18678/dtfd.1374498
AMA Apaydın AS, Güneş M, Köremezli Keskin N. Gender Differences in Balance, Lumbar Multifidus Muscle, Pain, and Kinesiophobia in Patients with Lumbar Spinal Stenosis. Duzce Med J. Nisan 2024;26(1):28-33. doi:10.18678/dtfd.1374498
Chicago Apaydın, Aydın Sinan, Musa Güneş, ve Nevin Köremezli Keskin. “Gender Differences in Balance, Lumbar Multifidus Muscle, Pain, and Kinesiophobia in Patients With Lumbar Spinal Stenosis”. Duzce Medical Journal 26, sy. 1 (Nisan 2024): 28-33. https://doi.org/10.18678/dtfd.1374498.
EndNote Apaydın AS, Güneş M, Köremezli Keskin N (01 Nisan 2024) Gender Differences in Balance, Lumbar Multifidus Muscle, Pain, and Kinesiophobia in Patients with Lumbar Spinal Stenosis. Duzce Medical Journal 26 1 28–33.
IEEE A. S. Apaydın, M. Güneş, ve N. Köremezli Keskin, “Gender Differences in Balance, Lumbar Multifidus Muscle, Pain, and Kinesiophobia in Patients with Lumbar Spinal Stenosis”, Duzce Med J, c. 26, sy. 1, ss. 28–33, 2024, doi: 10.18678/dtfd.1374498.
ISNAD Apaydın, Aydın Sinan vd. “Gender Differences in Balance, Lumbar Multifidus Muscle, Pain, and Kinesiophobia in Patients With Lumbar Spinal Stenosis”. Duzce Medical Journal 26/1 (Nisan 2024), 28-33. https://doi.org/10.18678/dtfd.1374498.
JAMA Apaydın AS, Güneş M, Köremezli Keskin N. Gender Differences in Balance, Lumbar Multifidus Muscle, Pain, and Kinesiophobia in Patients with Lumbar Spinal Stenosis. Duzce Med J. 2024;26:28–33.
MLA Apaydın, Aydın Sinan vd. “Gender Differences in Balance, Lumbar Multifidus Muscle, Pain, and Kinesiophobia in Patients With Lumbar Spinal Stenosis”. Duzce Medical Journal, c. 26, sy. 1, 2024, ss. 28-33, doi:10.18678/dtfd.1374498.
Vancouver Apaydın AS, Güneş M, Köremezli Keskin N. Gender Differences in Balance, Lumbar Multifidus Muscle, Pain, and Kinesiophobia in Patients with Lumbar Spinal Stenosis. Duzce Med J. 2024;26(1):28-33.
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