{"id":28936,"date":"2026-10-02T12:00:00","date_gmt":"2026-10-02T10:00:00","guid":{"rendered":"https:\/\/www.physiotutors.com\/?post_type=research&#038;p=28936"},"modified":"2026-10-03T16:26:09","modified_gmt":"2026-10-03T14:26:09","slug":"walking-after-lumbar-fusion","status":"publish","type":"research","link":"https:\/\/www.physiotutors.com\/research\/walking-after-lumbar-fusion\/","title":{"rendered":"Walking After Lumbar Fusion: Shorter Strides, Bigger Questions"},"featured_media":28935,"template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":""},"featured-tag":[],"tracking_tag":[2200,2192,2207],"class_list":["post-28936","research","type-research","status-publish","has-post-thumbnail","hentry","tracking_tag-diagnosis-imaging","tracking_tag-lumbar-sij","tracking_tag-surgery"],"acf":{"free_access":"unfree","app_link":"","sections":[{"acf_fc_layout":"page-header-small","background":{"background_image":28935,"background_image_alt_text":"Walking After Lumbar Fusion: Shorter Strides, Bigger Questions"},"heading":"Walking After Lumbar Fusion: Shorter Strides, Bigger Questions","subheading":"Putzolu and Claus et al., BMC Musculoskelet Disord. (2026)","benefits":[{"benefit":"Patients after lumbar fusion showed differences in gait despite similar walking speeds. Stride length and other spatial gait measures differed between groups, suggesting that walking speed alone may not capture all gait characteristics"},{"benefit":"Some gait differences were more apparent at preferred and fast walking speeds. Assessing patients at more than one walking speed may therefore provide additional information about their gait pattern"},{"benefit":"The observed gait differences cannot be attributed to surgery itself. Because the study had no preoperative measurements and no non-surgical chronic low back pain comparison group, it remains unclear whether these differences were pre-existing or developed after lumbar arthrodesis"}]},{"acf_fc_layout":"content","background_color":"none","content_alignment":"left","content_editor":"<h2>Introduction<\/h2>\r\nSome people suffering from chronic low back pain get referred on when a trial of conservative management has proven to be insufficient in curing their pain. One of the possible surgical approaches in this cohort is a lumbar spine fusion (lumbar arthrodesis). This surgical approach immobilizes one or more intervertebral joints at the lumbar spine. A lot of research has already delved into the postoperative outcomes of pain, disability, and quality of life, but functional outcomes remain barely investigated. One of the functional domains that has gotten little attention is that of posture and gait. Therefore, this study wanted to take a leap forward into comparing gait characteristics of a healthy cohort with people after lumbar fusion surgery.\r\n\r\n&nbsp;\r\n<h2>Methods<\/h2>\r\nThis was an analytic cross-sectional study, in which the researchers examined a group of people after instrumented lumbar arthrodesis to healthy controls. Participants were recruited between May 2021 and March 2022.\r\n\r\n&nbsp;\r\n<h3>Posture assessment<\/h3>\r\nLumbar lordosis and thoracic kyphosis were measured with a VICON motion-capture system using the A-Palp method. The examiner manually palpated the spine from the external occipital protuberance down to S2 using a fingertip-supported device carrying reflective markers. The spinal trajectory was digitized three times.\r\n\r\nFrom this reconstructed spinal curve, the researchers calculated the lumbar lordosis and thoracic kyphosis using tangent lines positioned at spinal inflection points. These were not standard standing X-rays. The researchers reconstructed the external spinal contour through palpation and motion capture. It is therefore a sophisticated laboratory measure of sagittal curvature rather than a direct radiographic Cobb-type assessment.\r\n\r\n<img src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2026\/09\/walking-after-lumbar-fusion-image-1.jpg\" alt=\"Walking After Lumbar Fusion: Shorter Strides, Bigger Questions\" \/>\r\n\r\n&nbsp;\r\n<h3>Gait assessment<\/h3>\r\nParticipants walked over a 6.10-metre Zeno pressure-sensitive walkway. They started approximately 2 metres before the walkway and continued approximately 2 metres beyond it to reduce acceleration and deceleration effects.\r\n\r\nEach participant completed two rounds at slow speed, preferred speed, and fast speed, resulting in 12 walkway passes.\r\n\r\nFrom these, the researchers measured the following <a href=\"https:\/\/www.physiotutors.com\/wiki\/gait-cycle-gait-analysis\/\" target=\"_blank\" rel=\"noopener\">gait cycle<\/a> variables:\r\n<ul>\r\n \t<li>foot progression angle<\/li>\r\n \t<li>step\/stride length<\/li>\r\n \t<li>stride width<\/li>\r\n \t<li>stride velocity<\/li>\r\n \t<li>stance phase<\/li>\r\n \t<li>swing phase<\/li>\r\n \t<li>single support<\/li>\r\n \t<li>double support<\/li>\r\n \t<li>walking speed<\/li>\r\n \t<li>cadence<\/li>\r\n<\/ul>\r\n&nbsp;\r\n<h2>Results<\/h2>\r\nThe study included 13 patients after instrumented lumbar arthrodesis, 5 women and 8 men, with a mean age of 50.7 \u00b1 8.7 years. Their BMI was 28.5 \u00b1 3.0 kg\/m\u00b2. Seven had a one-level fusion, while 6 had a two-level fusion.\r\n\r\nNext, fifteen healthy controls, 6 women and 9 men, with a mean age of 52.5 \u00b1 10.0 years and a BMI of 27.6 \u00b1 3.0 kg\/m\u00b2, were included.\r\n\r\nThe analysis of spinal curvature did reveal that there was no statistically significant difference between groups in lumbar lordosis or thoracic kyphosis.\r\n\r\n<img src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2026\/09\/walking-after-lumbar-fusion-image-2.jpg\" alt=\"Walking After Lumbar Fusion: Shorter Strides, Bigger Questions\" \/>\r\n\r\nConsidering the gait analysis, three variables stood out.\r\n\r\n&nbsp;\r\n<h3>1. Stride length was consistently shorter<\/h3>\r\nStride length was significantly reduced in the arthrodesis group at all three walking speeds. This is probably the clearest gait finding of the study.\r\n\r\n&nbsp;\r\n<h3>2. Stride width was narrower<\/h3>\r\nAt preferred speed and at fast speed.\r\n\r\n&nbsp;\r\n<h3>3. Foot progression angle was greater at fast speed<\/h3>\r\nThe patients therefore walked with slightly more externally oriented feet, particularly under the greater demands of fast walking.\r\n\r\n<img src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2026\/09\/walking-after-lumbar-fusion-image-3.jpg\" alt=\"Walking After Lumbar Fusion: Shorter Strides, Bigger Questions\" \/>\r\n\r\nThere were no statistically significant between-group differences in:\r\n<ul>\r\n \t<li>walking speed<\/li>\r\n \t<li>stride velocity<\/li>\r\n \t<li>cadence<\/li>\r\n \t<li>stance percentage<\/li>\r\n \t<li>single-support percentage<\/li>\r\n \t<li>double-support percentage<\/li>\r\n<\/ul>\r\n&nbsp;\r\n<h3>Correlations between spinal curvature and gait<\/h3>\r\nTable 3 shows the Pearson correlation coefficients between spinal curvature and gait variables. Most coefficients were small. In the arthrodesis group, the largest coefficient was between thoracic kyphosis and foot progression angle at preferred walking speed (r = -0.53).\r\n\r\n<img src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2026\/09\/walking-after-lumbar-fusion-image-4.jpg\" alt=\"Walking After Lumbar Fusion: Shorter Strides, Bigger Questions\" \/>\r\n\r\nFigures 2 and 3 visualize the relationships between foot progression angle and lumbar lordosis and thoracic kyphosis, respectively. Although negative associations were observed, the p-values reported in the figures were not statistically significant.\r\n\r\n<img src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2026\/09\/walking-after-lumbar-fusion-image-5.jpg\" alt=\"Walking After Lumbar Fusion: Shorter Strides, Bigger Questions\" \/>\r\n<img src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2026\/09\/walking-after-lumbar-fusion-image-6.jpg\" alt=\"Walking After Lumbar Fusion: Shorter Strides, Bigger Questions\" \/>\r\n\r\n&nbsp;\r\n<h2>Questions and thoughts<\/h2>\r\nA crucial part of the design has to be remembered when looking at these insights. As this was a cross-sectional study, we can not simply speak of gait adaptations following lumbar spine arthrodesis surgery. A cross-sectional design implies that only one measurement is obtained. Here, the measurement was obtained at one specific point in time in people following lumbar arthrodesis, and this was compared against a group of healthy people who were measured just once. So, as this is not a classical pre-post design, the use of gait \u201cadaptations\u201d is in my opinion slightly misleading. A cross-sectional comparison can identify differences between groups, but it cannot establish that these differences represent adaptations that developed as a consequence of surgery. We all move slightly differently, and there is no single universally correct gait pattern, nor should there be. Furthermore, we are also unaware whether these patients moved differently already before their surgery (because of pain, fear of movement, protective behaviors, etc) or the surgery got them to move differently. That is one inherent limitation of a cross-sectional study. Therefore, this study can be used for hypothesis generation and exploration, but should not be used as \u201cproof that surgery leads to gait adaptations\u201d.\r\n\r\nSomething that struck me while reading this paper was the huge emphasis on structural issues within the body. While we are already far beyond the pain equals damage construct, it appeared that this paper still was focusing a lot on these \u201cabnormalities\u201d. For example, the introduction stated:\r\n\r\n<em>\u201cFirst-line management typically involves analgesic medications, particularly nonsteroidal anti-inflammatory drugs, while second-line pharmacological options may include opioids, tricyclic antidepressants, muscle relaxants, and gabapentin. Non-pharmacological treatments such as physiotherapy, psychotherapy, acupuncture, ultrasound therapy, lumbar braces and orthoses, transcutaneous electrical nerve stimulation, and yoga can serve as adjuncts or alternatives. Among invasive non-surgical interventions, epidural or intra-facet corticosteroid injections and radiofrequency nerve ablation are commonly employed. Orthopedic insoles have demonstrated improvements in low back pain for patients with pronated feet, which can induce structural and biomechanical deficits during gait affecting the lumbar region. However, their efficacy across all etiologies of low back pain remains uncertain. When conservative approaches fail, surgical intervention may be considered.\u201d<\/em>\r\n\r\nThere are a few things worth unpacking in this statement. First of all, while physiotherapy is not an \u201cadjunct or alternative\u201d according to the <a href=\"https:\/\/www.who.int\/publications\/i\/item\/9789240081789\" target=\"_blank\" rel=\"noopener\">WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings<\/a>, this paper positions the use of physiotherapy and exercise-based interventions as alternatives to do in chronic low back pain. That framing seems outdated. Second, they put ultrasound, TENS, and braces in the same place as physiotherapy, while the WHO guidelines explicitly recommend against the use of these modalities. Third, they propose orthopedic insoles for those with pronated feet, as this foot positioning can <em>\u201cinduce structural and biomechanical deficits during gait affecting the lumbar region\u201d<\/em>. That wording risks being nocebic, and it is probably too simplistic. Lastly, the statement that surgery may become necessary once conservative care \u2018fails\u2019 deserves some nuance. If I had a patient with chronic low back pain and started with NSAIDs, followed by ultrasound, TENS, and perhaps custom-fitted insoles, while taking physiotherapy as an adjunct, I would not be surprised if that conservative pathway failed, especially when this is accompanied by potentially nocebic language about structural and biomechanical deficits.\r\n\r\nAlthough the American Pain Society proposes surgical management (with lumbar spinal fusion and\/or disc replacement) outside of emergency cases when degenerative pathology persists despite at least one year of appropriate conservative care, it is our job to do better. Once a patient is labelled as having \u201cfailed conservative care\u201d, it becomes easy to assume that surgery is the only remaining option.\r\n\r\nAn orthopedic spine specialist would assume that once a patient has tried conservative care and had no improvement, there is nothing left to do except try surgery. But ask yourself first whether you tried the most evidence-based options: structured and standardized education and advice, structured exercise therapy, cognitive behavioural therapy (CBT), multicomponent biopsychosocial care delivered by a multidisciplinary team, before concluding that conservative care \u201cfails\u201d. Only then does the label \u201cfailed conservative care\u201d become more meaningful, but not simply because they have tried insoles, TENS and ultrasound, while simultaneously reinforcing a structural threat narrative.\r\n\r\nTo their credit, the authors are considerably more cautious later in the discussion, where they acknowledge that the observed gait differences cannot be attributed specifically to arthrodesis and may instead reflect chronic low back pain or previous rehabilitation.\r\n\r\n&nbsp;\r\n<h2>Talk nerdy to me<\/h2>\r\nTable 3 deserves some attention. It reports the magnitude and direction of the correlation coefficients, but not their p-values or confidence intervals. That means the table tells us how large the observed associations were in this sample, but not how precise or statistically convincing they were. This makes it difficult to judge the statistical (un)certainty around the reported weak-to-moderate associations and may make the categorical labels \u2018weak\u2019 or \u2018moderate\u2019 appear more convincing than the underlying evidence warrants.\r\n\r\nFigures 2 and 3 help illustrate this. Figure 2 shows the relationship between lumbar lordosis and foot progression angle in the arthrodesis group, while Figure 3 shows the relationship between thoracic kyphosis and foot progression angle. The plotted relationships are negative, but the reported p-values in these figures were not statistically significant. In other words, the sample showed a tendency for greater spinal curvature to be associated with a smaller foot progression angle, but the data were not strong enough to conclude that these relationships are unlikely to be due to chance.\r\n\r\nFigure 2 also reports an R\u00b2 of approximately 0.17. R\u00b2 is the coefficient of determination and is simply the squared correlation coefficient. An R\u00b2 of 0.17 means that, within this sample, about 17% of the variation in foot progression angle was statistically accounted for by its linear relationship with lumbar lordosis. That does not mean lumbar lordosis caused 17% of the foot progression angle, and because the relationship was not statistically significant, it should not be treated as a robust explanatory finding.\r\n\r\nAnother issue is the large number of correlations that were explored. The authors correlated two spinal curvature measures with numerous gait variables across three walking speeds and in two groups. The more statistical comparisons that are performed, the greater the chance that some apparently interesting coefficients will appear simply by chance. The authors acknowledge that the correlation analyses were exploratory, but no correction for multiple comparisons was reported.\r\n\r\nThe small sample size further complicates interpretation. With only 13 patients in the arthrodesis group, even a moderate-sized correlation coefficient can remain statistically non-significant because the estimate is imprecise. This is why an observed value such as r = -0.53 can reasonably be described as a moderate coefficient, but not as convincing evidence of a true relationship.\r\n\r\nImportantly, postoperative information such as pain intensity, disability, medication use, and rehabilitation history was not consistently available. I would want to know whether these people had undergone surgery long ago, or only recently. How did they rehabilitate following their surgery? Were they fearful of movement and cautious upon walking? Not knowing all these important factors is like assessing blindly. For us, the most transferable part of this method is probably the multi-speed assessment. The findings suggest that evaluating someone only during comfortable walking may miss adaptations that become more visible when walking faster.\r\n\r\nInterestingly, the patients did not adopt a wider base of support, which we might expect if they were simply seeking greater stability. The authors speculate that the narrower gait could reflect reduced pelvic excursion, reduced trunk motion, or a generally more rigid gait strategy, but they did not directly measure these mechanisms. Also, contrary to what we might assume, the surgical group did not necessarily walk slower than the controls. Instead, some aspects of how they produced that walking speed differed. The finding of the difference in foot progression angle, where the surgical cohort walked with slightly more externally orientated feet during fast walking, should not be interpreted as a lumbar-specific compensation, as this is influenced by many structures, including hip rotation, pelvic movement, tibial torsion and foot alignment.\r\n\r\n&nbsp;\r\n<h2>Take-home messages<\/h2>\r\nRelatively important to remember is the fact that this study examined differences between two different groups at only one point in time.\r\n\r\nPatients who had undergone lumbar fusion walked somewhat differently from healthy controls despite having similar walking speeds. The clearest differences were shorter stride lengths during slow, preferred, and fast walking. Patients also walked with a narrower stride width at preferred and fast speeds and showed a slightly larger foot progression angle during fast walking.\r\n\r\nInterestingly, their lumbar lordosis and thoracic kyphosis were not significantly different from those of healthy controls. This suggests that static sagittal curvature alone may not capture functional differences visible during walking.\r\n\r\nGait assessment may offer additional information after lumbar arthrodesis, particularly when patients are assessed at more than one walking speed. However, it remains unclear whether the observed gait differences developed after surgery or were already present before it. The major threat to the conclusion is that the researchers never measured these patients before surgery. We therefore cannot determine whether the gait differences were caused by lumbar arthrodesis, persisted from their previous chronic low back pain, or resulted from some combination of pain, surgery and rehabilitation.\r\n\r\n&nbsp;\r\n<h2>Reference<\/h2>\r\n<a href=\"https:\/\/doi.org\/10.1186\/s12891-026-10264-7\" target=\"_blank\" rel=\"noopener\">Putzolu, A., Claus, G., Delafontaine, A. et al. Gait adaptations and spinal curvature correlations following lumbar arthrodesis: an analytic cross-sectional study. BMC Musculoskelet Disord (2026). doi: 10.1186\/s12891-026-10264-7<\/a>"},{"acf_fc_layout":"author","author":{"":null,"image":25230,"image_alt_text":"Ellen Vandyck","name":"Ellen Vandyck","function_or_description":"Research Manager"}}]},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Gait Changes After Lumbar Fusion: What the Evidence Shows<\/title>\n<meta name=\"description\" content=\"This study compared gait after lumbar fusion to healthy controls: shorter strides, narrower steps, but questions remain.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.physiotutors.com\/research\/walking-after-lumbar-fusion\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Gait Changes After 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