Tracking the disease progression of lumbar spinal stenosis using objective gait metrics: a case report

We present the case of an 85-year-old woman who presented to our clinic with neurogenic claudication due to lumbar spinal stenosis (LSS) over a period of two years. During this time a series of walking metrics were monitored including daily step count, walking speed, and step length. All metrics showed a deterioration over time and objectively document the disease progression of LSS (initial: walking speed =1.03 m/s, step length =0.49 m, and daily step count =3,136; final: walking speed =0.49 m/s, step length =0.37 m, and daily step count =334). At this time, the patient had also begun experiencing bilateral lower limb weakness and paraesthesia upon exertion, preventing her from mobilizing for more than a few meters at a time. After a shared decision-making process with the patient and her family, surgical management was recommended. The deterioration of the patient's walking metrics matched their increasing requirement for walking assistance, with no walking assistance being needed initially, compared to a four-wheel walker being required in the weeks prior to her surgery. Therefore, the extent of walking deterioration may be able to inform clinical decision-making regarding appropriate walking assistance. To our knowledge, this is the first report that objectively documents the deterioration of LSS using walking metrics for such a prolonged duration of time.