Northwestern University Feinberg School of Medicine

Northwestern University Prosthetics-Orthotics Center

Evaluation of Spinal Motion in Persons with Transfemoral Amputations: Relationship to Low-Back Pain

Co-Investigator: Stefania Fatone, PhD

Project Director: Rebecca Stine, MS

Post-doctoral Fellow: Pranitha Gottipati, PhD; Azucena Rodriguez, PhD** (Fellowship funded by National Institutes of Health-Institutional Research and Academic Career Development Award, K12 Program)

** Department of Electrical Engineering, Northwestern University

Funded by: National Institute on Disability and Rehabilitation Research (NIDRR) H133E080009

Status: In Progress

Introduction

Low back pain is a prevalent condition among the general population with causes ranging from musculoskeletal impairment, gait abnormalities, excessive activity or overuse, along with a variety of other issues. Low back pain has been rated as more bothersome than either phantom limb pain or residual limb pain by persons with lower extremity amputations.

Although it has been suggested that gait abnormalities may contribute to low back pain, there have been limited investigations that have attempted to correlate low back pain to kinematic variables, especially spinal motions. Typically, gait analysis models disregard the spine entirely or regard it as a single rigid structure. Data on regional spinal movements, in conjunction with lower limb data, associated with walking are scarce. As such our understanding of spinal motion in both able-bodied persons and those with amputation has been limited. Yet understanding spinal motion and compensations during walking would improve our comprehension of the factors contributing to low back pain and lead to interventions designed to alleviate low back pain.

Spine Kinematic model marker set and wireframe model

Specific Objectives

We intend to investigate whether there are kinematic differences during walking in persons with transfemoral amputations that have low back pain compared to persons with transfemoral amputations without low back pain. This study has two objectives: (1) to compare lower body kinematics and spinal kinematics in persons with transfemoral amputations with and without low back pain, and (2) to determine if there are any kinematic differences between the two groups that help explain the presence of low back pain in prosthesis users. The Figure shows our spine kinematic model marker set and wireframe model (see Konz et al. 2006).

Clinical Implications

It has been established that low back pain is prevalent in persons with transfemoral amputations. Identification of differences in motion, especially spinal motion, during walking between transfemoral amputees with and without low back pain will improve our understanding of the contributing factors and suggest potential interventions that may decrease the prevalence of low back pain in persons with transfemoral amputation.

References

Konz R, Fatone S, Stine R, Ganju A, Gard S and Ondra S (2006) A Kinematic Model to Assess Spinal Motion During Walking. Spine, 31(24):E898-E906. 17108818

Publications

Fatone S, Stine R, Gottipati P, Dillon M (2015) Pelvic and Spinal Motion during Walking in Persons with Transfemoral Amputation with and without Low Back Pain. American Journal of Physical Medicine and Rehabilitation, Oct 22. [Epub ahead of print]. PMID: 26495814.

Presentations

Stine R, Gottipati P, Dillon M, Fatone S (2016) Pelvic and Spinal Motion during Walking in Persons with Transfemoral Amputation with and without Low Back Pain. NUPOC Biennial Symposium for the German-Speaking Travel Fellows of Initiative '93, February 25, Chicago, IL.

Rodriguez A, Stine R, Fatone S (2011) Spinal Motion during Walking in Persons with Transfemoral Amputation with and Without Low Back Pain, in 1st Annual Movement and Rehabilitation Sciences (MRS) Training Day. Northwestern University, August 23, Chicago, IL.

Rodriguez A, Stine R, Fatone S (2011) Spinal motion during walking in persons with unilateral transfemoral amputation with and without low back pain. in Midwest Chapter of the American Academy of Orthotists and Prosthetists Fall Meeting, November 12, Hickory Hills IL.

Rodriguez A, Stine R, Fatone S, Gard S (2012) Spinal motion during walking in persons with unilateral transfemoral amputation with and without low back pain. in 38th American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium, March 21-24, Atlanta, GA.

Rodriguez A, Stine R, Gard S, Fatone S (2012) Spinal motion during walking in persons with unilateral transfemoral amputation with and without low back pain. American Academy of Orthotists and Prosthetists Webinar Series, August 22. Archived online at: http://www.oandp.org/olc/course_video.asp?frmCourseId=4E0ABC59-B731-4646-9756-16D5B3F9FD42 

Fatone S, Stine R, Rodriguez A, Gard S (2013) Spinal motion during walking in persons with unilateral transfemoral amputation with and without low back pain. 14th World Congress of the International Society of Prosthetics and Orthotics, February 4-7, Hyderabad, India.