Effect of Lumbar Surgery on Complexity During a Walking Task in Chronic Low Back Pain

Study Overview
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Brief Summary
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Lumbar surgery is the most common treatment for chronic disabling low back pain with degenerative disc disease. There are few elements to objectively evaluate the improvement of the motor control after surgery and the motor adaptation capacities of the patients. The impact of lumbar surgery on complexity in this painful context has never been studied. Theoretically, the restriction of mobility imposed by lumbar surgery should limit the subject's adaptive capacities (of one or more lumbar segments) and thus reduce complexity. Nevertheless, improvement in pain intensity levels could allow the patient to find better motor adaptation capacities, necessary for a positive evolution in the long-term. The aim of this study was to investigate the evolution of gait complexity in chronic low back pain patients pre- and post-surgery. If surgery improves the adaptability of walking through an antalgic benefit exceeding the induced stiffness, the complexity of walking should be superior after surgery. This is a proof-of-concept study in which the study investigators hypothesize that measuring complexity by fractal analysis during a walking task will show the increase in gait complexity induced by lumbar surgery at 3 and 6 months after surgery.

Official Title
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Effect of Lumbar Surgery on Complexity During a Walking Task in the Chronic Low Back Pain Patient

Conditions
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Low Back Pain

Intervention / Treatment
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* Other: Walking task


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with chronic low back pain requiring prosthesis or arthrodesis surgery on one or two levels Subject affiliated or beneficiary of a health insurance plan. The patient must have given their free and informed consent Exclusion Criteria: Patients with organic low back pain (infection, tumor, inflammatory rheumatism) Patient with a neurological deficit (cauda equina syndrome or motor testing MRC < 3 on a muscle group of the lower limbs) Patient who has already undergone lumbar surgery (except single discectomy) Patient with serious concomitant pathologies Patients participating in a therapeutic study prohibiting participation in another study Patient in an exclusion period from a different study It is impossible to give the subject informed information Patient is unable to express consent The patient is under safeguard of justice or state guardianship Patient is pregnant, parturient or breastfeeding

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients with Low Back Pain<br> | Other: Walking task<br>* Treadmill walking task with study of fractal variability (complexity) for 10 minutes.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Gait complexity | fractal analysis of gait variability: value normally between 0.5 (degraded structure) to 1 (optimal structure) | 10 days before surgery +/- 3 days | 
| Gait complexity | fractal analysis of gait variability: value normally between 0.5 (degraded structure) to 1 (optimal structure) | Month 3 | 
| Gait complexity | fractal analysis of gait variability: value normally between 0.5 (degraded structure) to 1 (optimal structure) | Month 6 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient reported pain | Visual analog scale (0-100) | 10 days before surgery +/- 3 days | 
| Patient reported pain | Visual analog scale (0-100) | Month 3 | 
| Patient reported pain | Visual analog scale (0-100) | Month 6 | 
| Apprehension of pain of movement | Tampa Scale of Kinesiophobia. Score ranging from 17-68. Higher scores denote greater level of kinesiophobia (a score >40 is considered significant kinesiophobia) | 10 days before surgery +/- 3 days | 
| Apprehension of pain of movement | Tampa Scale of Kinesiophobia. Score ranging from 17-68. Higher scores denote greater level of kinesiophobia (a score >40 is considered significant kinesiophobia) | Month 3 | 
| Apprehension of pain of movement | Tampa Scale of Kinesiophobia. Score ranging from 17-68. Higher scores denote greater level of kinesiophobia (a score >40 is considered significant kinesiophobia) | Month 6 | 
| Patient reported quality of life | EuroQol-5 Dimension questionnaire: results generated as 5 digit number corresponding to different aspects of quality of life | 10 days before surgery +/- 3 days | 
| Patient reported quality of life | EuroQol-5 Dimension questionnaire: results generated as 5 digit number corresponding to different aspects of quality of life | Month 3 | 
| Patient reported quality of life | EuroQol-5 Dimension questionnaire: results generated as 5 digit number corresponding to different aspects of quality of life | Month 6 | 
| Correlation between type of surgery and gait variability | Classified as either arthrodesis or prosthesis | 10 days before surgery +/- 3 days | 
| Correlation between type of surgery and gait variability | Classified as either arthrodesis or prosthesis | Month 3 | 
| Correlation between type of surgery and gait variability | Classified as either arthrodesis or prosthesis | Month 6 |