Preoperative and Postoperative Spatiotemporal Gait Parameters and Gait Asymmetry in Patients With Lumbar Disc Herniation: a Prospective, Cross-sectional Study
Phase: NA
Conditions: Lumbar Disc Herniation, Pain
Sponsor: Marmara University

Date: January 1, 2018 
 
 
 
 
Official Title: Preoperative and postoperative spatiotemporal gait parameters and gait 
asymmetry in patients with lumbar disc herniation: a prospective, cross-sectional study 
 
 
 
 
Principal Investigators 
MASOUD AMIR RASHEDI BONAB, PT, MSc 
Phone number: +905539271700 
Mail address: fzt.mesutamir@gmail.com 
Address: Bahçeşehir University Goztepe Medical Park Hospital, Brain and Spine Surgery 
Department,Istanbul, Turkey 
 
 
 
Study Director 
Assoc. Prof. TUGBA KURU COLAK, PT, PhD 
Phone number: +905359512440 
Mail address: tugbakuru@gmail.com 
Address: Marmara University Faculty of Health Science, Physiotherapy and Rehabilitation 
Department, Istanbul, Turkey. 
 
 
 
The study has no clinical trials registration number yet. 

Excluded (n= 25) 
Not meeting inclusion criteria (n= 15) 
Declined to participate (n= 10) 
Other reasons (n= 0) 
Assessed for eligibility (n= 243) 
Analyzed the 59 participants who had the planned 
lumbar discectomy surgery of 153 Lumbar Disc 
Herniation patients, were tested before 
(preoperative) and 15 days after surgery 
(postoperative). 
Study Protocol 
 
 
 
Participant Flow 
 
 
 
 
 
 
 
 
 
Follow-Up 
Lost to follow-up (n= 0) 
Discontinued observation (n= 0) 
Lost to follow-up (n= 0) 
Discontinued observation (n= 0) 
 
Analysis 
Analysed (n= 153) 
Excluded from analysis (Extreme difficulty in 
walking) (n=11) 
Analysed (n= 54) 
Excluded from analysis (n= 0) 
 
 
 
Healthy Control (n= 54) 
Lumbar Disc Herniation 
(n= 164) 

INTRODUCTION 
 
Lumbar disc herniation (LDH) is a localized displacement of the lumbar intervertebral disc 
into the vertebral canal or intervertebral space, and is considered as a mechanical disorder 
characterized by degeneration of the disc.1-3 Disc herniation leads to functional loss and 
disability in daily life activities and negatively affects the quality of life among these 
patients.4-6 Depending on LDH in sprawling of pain to spine and legs, lower extremity 
functions, especially walking, are adversely affected and usually walk slower than their 
healthy individuals.7-9 The gait parameters are important gait variables, because they can be 
easily evaluated and measured to obtain gait deviations and walking difficulties, make a 
diagnosis, determine appropriate therapy, monitor the patient's progress, determine the 
prognosis, and they can help in understanding the functional limitations during gait. 
 
AIM 
The aim of this study was to emphasize on the interaction of spatial and temporal gait 
parameters and gait asymmetry in patients with Lumbar Disc Herniation (LDH). 
 
 
METHODS 
 
Study Design 
This study is an observational, prospective, and cross-sectional study. This study recruited 
patients diagnosed with Lumbar Disc Herniation between May 2016 and December 2017 at 
Bahçeşehir University Goztepe Medical Park Hospital, Brain and Spine Surgery Department. 
Prior to conducting the investigation, ethical clearance was obtained from the ethics 
committee of the Bahçeşehir University Faculty of Medicine (22481095-020-482, 2016- 
04/07), and it was performed in terms of the guidelines of the Declaration of Helsinki. 
 
Inclusion criteria 
 
(1) Individuals who were diagnosed with LDH by a specialist; 
(2) Patients had a medical history and proven by MRI with more or less evidence of 
degenerative lumbar disc; 
(3) Aged between 25-80 years old; 
(4) Pain symptom on lumbal area or lower extremity. 

Exclusion criteria 
(1) Patients who have previously received a surgery or physical therapy treatment; 
(2) Having congenital deformity in the spine or lower extremity; 
(3) History of spinal surgery or other diseases affecting gait; 
(4) Pregnancy; 
(5) Situations that may cause gait balance problems; 
(6) Using assistive gait appliance. 
 
 
Participants 
In total, 207 participants were included in this study as 153 patients with LDH (71 females, 82 
males) and 54 healthy individuals in the control group (27 females, 27 males). 
 
 
Procedure 
In this study, the Analysis of the spatial and temporal gait assessment was performed using 
“Win-Track” gait analysis platform system (Medicapteurs, Balma, France). The dimensions 
of this device are 1610 mm × 652 mm × 30 mm (length/width/height); the thickness of the 
platform is 9 mm composed of 12288 resistive type sensors. The dimensions of these sensors 
are 7.8 × 7.8 mm2, and the acquisition frequency of the apparatus is up to 200 images/s 
enabling digitally recording the spatiotemporal information of subjects’ gait based on the 
center of foot pressure. The participants were asked to continuously walk barefoot for ten 
times in their normal walking speed as straight as possible without any gait assist device on 
the “Win-Track” platform within the same day. The pain intensity of the patients was 
evaluated and recorded by a Visual Analog Scale (VAS) immediately before performing the 
analysis. Three flawless walking values analysis of spatiotemporal gait parameters were 
recorded and the arithmetic means were computed with three repetitions. Whenever they were 
about to take a rest, the patients were allowed to sit down on a chair. In addition, the analysis 
of spatiotemporal gait parameters and gait asymmetry of 59 participants who had the planned 
lumbar discectomy surgery, was tested before and 15 days after surgery. The analysis of the 
spatiotemporal gait parameters was performed on the healthy control group's participants by 
the same investigator using the same equipment and measurement protocol. The gait 
symmetry index was used to calculate the walking asymmetry.  

Main Outcome Measures 
 
The demographic data of the participants were recorded on a personal information form on 
the computer. 
We used to Visual Analog Scale (VAS) for the Evaluation of Pain intensity. 
 
The spatio-temporal data included the following values: step duration (seconds), gait cycle 
duration (seconds), double stance duration (seconds), swing duration (seconds), step length 
(cm), gait cycle length (cm), velocity (cm/s), and cadence (step/min); and these parameters 
were separately recorded for right and left extremity. 
The gait symmetry index (Symmetry Index= 2*|X_R-X_L |/(X_R+X_L)*100%) was used to 
calculate the asymmetry between the left and right extremities during walking as a percentage.   
 
Reporting of results 
The results of this study will be presented at national and/or international meetings and will be 
published in journals. 
 
Key Words: Lumbar disc herniation, Gait analysis, Spatiotemporal gait parameters, Pain, Gait asymettry 
 
 
Funding: No 
 
 
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