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Laett CT, Visconti RDR, Meirelles RDSP, Santos LDM, Cossich VRA, Silva SCD. Effect of Spinal Correction Surgery on Lower Limb Strength in Idiopathic Adolescent Scoliosis. Rev Bras Ortop 2023; 58:e912-e916. [PMID: 38077772 PMCID: PMC10708971 DOI: 10.1055/s-0043-1770980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/27/2023] [Indexed: 08/03/2024] Open
Abstract
Objectives To analyze the lower limb strength in both untreated and surgically treated adolescent idiopathic scoliosis (AIS) patients and examine its correlation with the distance covered in a six-minute walking test (6MWT). Methods A total of 88 participants (n = 30 pre-surgery AIS patients, n = 30 post-surgical AIS patients, and n = 28 control) underwent a 6MWT and a muscle strength assessment. The lower limb strength was measured at the knee joint using the knee extension (KE) and knee flexion (KF) peak torque (PT) measurements. Results The control group covered a greater distance in the TC6 compared to both the pre-surgical (534 ± 67 m) and post-surgical (541 ± 69 m) groups, with a distance of 612 ± 70 m (p < 0.001). No differences were observed in KE PT (pre: 2.1 ± 0.63, post: 2.1 ± 0.7, control: 2.2 ± 0.7 Nm.kg -1 , p = 0.67) or KF PT (pre: 1.0 ± 0.3, post: 1.1 ± 0.3, control: 1.1 ± 0.5 Nm.kg -1 , p = 0.46). A moderate positive correlation was observed between KE PT and 6MWT distance (r = 0.53, p < 0.001), as well as a low positive correlation for KF PT (r = 0.37, p = 0.003) with 6MWT distance. Conclusion This study highlights the importance of lower limb maximal strength in the functionality of AIS patients. Our findings suggest that exercise programs aimed at enhancing lower limb strength, especially the KE, could improve the walking capacity of AIS patients. These results provide useful information for designing purposeful exercise programs for AIS patients with walking deficits.
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Affiliation(s)
- Conrado Torres Laett
- Instituto Nacional de Traumatologia e Ortopedia (INTO), Divisão de Ensino e Pesquisa (DIENP), Programa de Pós-Graduação em Ciências Aplicadas ao Sistema Musculoesquelético, Rio de Janeiro, RJ. Brasil.
- Instituto Nacional de Traumatologia e Ortopedia (INTO), Laboratório de Pesquisa em Fisiologia do Exercício, Divisão de Pesquisa, Rio de Janeiro, RJ, Brasil.
- Instituto Nacional de Traumatologia e Ortopedia (INTO), Laboratório de Pesquisa Neuromuscular, Divisão de Pesquisa, Rio de Janeiro, RJ, Brasil.
| | - Rogério dos Reis Visconti
- Instituto Nacional de Traumatologia e Ortopedia (INTO), Divisão de Ensino e Pesquisa (DIENP), Programa de Pós-Graduação em Ciências Aplicadas ao Sistema Musculoesquelético, Rio de Janeiro, RJ. Brasil.
| | | | - Lenifran de Matos Santos
- Programa de Pós-Graduação em Ciências do Exercício e do Esporte, Universidade Estadual do Rio de Janeiro, RJ, Brasil.
| | | | - Sidnei Cavalcante da Silva
- Instituto Nacional de Traumatologia e Ortopedia (INTO), Divisão de Ensino e Pesquisa (DIENP), Programa de Pós-Graduação em Ciências Aplicadas ao Sistema Musculoesquelético, Rio de Janeiro, RJ. Brasil.
- Instituto Nacional de Traumatologia e Ortopedia (INTO), Laboratório de Pesquisa em Fisiologia do Exercício, Divisão de Pesquisa, Rio de Janeiro, RJ, Brasil.
- Instituto Nacional de Traumatologia e Ortopedia (INTO), Laboratório de Pesquisa Neuromuscular, Divisão de Pesquisa, Rio de Janeiro, RJ, Brasil.
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Wong DLL, Mong PT, Ng CY, Ong CK, Qian Z, Shao MH, Sin LKE, Wong BY, Wong CM, Cheung JPY, To M. Can anterior vertebral body tethering provide superior range of motion outcomes compared to posterior spinal fusion in adolescent idiopathic scoliosis? A systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3058-3071. [PMID: 37256367 DOI: 10.1007/s00586-023-07787-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/03/2023] [Accepted: 05/17/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE Anterior vertebral body tethering (AVBT) was introduced as a fusionless alternative to treating adolescent idiopathic scoliosis (AIS) while preserving range of motion (ROM). This is the first systematic review to compare the ROM outcomes between AVBT and PSF in treating AIS. METHODS We conducted a comprehensive search on PubMed, EMBASE, MEDLINE, and Cochrane Library. Inclusion criteria were patients with AIS treated with AVBT or PSF or both, and clearly defined ROM outcomes; exclusion criteria were scoliosis other than AIS, biomechanical or cadaveric studies, non-English publications, case reports, conference summaries, unpublished literature, commentaries, and reviews. Primary outcome was ROM. Secondary outcomes included Cobb angle correction, quality of life (QOL), complications, and muscle strength and endurance. RESULTS Twelve studies were included in this review. We found moderate evidence to support that AVBT results in superior ROM outcomes than PSF while achieving comparable Cobb angle correction with low evidence. The comparison of QOL outcomes between AVBT and PSF remained inconclusive. In addition to the complications noted conventionally in PSF, AVBT could result in over-correction and distal adding-on. We also found very low evidence to support that AIS patients treated with AVBT have superior muscle strength and endurance when compared to those treated with PSF. CONCLUSIONS AVBT provides better preservation of ROM and muscle strength postoperatively when compared with PSF, while achieving comparable curve correction. Future studies should explore the spinal growth trajectory to determine the window of opportunity for AVBT in AIS.
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Affiliation(s)
- Darren Li Liang Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Pak Tung Mong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Chun Yin Ng
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Chun Kwan Ong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Zhekai Qian
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Mang Hong Shao
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Ling Kwan Ernest Sin
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Bao Yi Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Chun Ming Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China.
| | - Michael To
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China.
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Sklensky J, Urbasek K, Svehlik M, Svozilova V, Kocanda J, Prymek M, Vyskocil R, Repko M. The relationship of hip loading asymmetry and radiological parameters of the spine in Lenke type 1 idiopathic scoliosis. Gait Posture 2022; 94:160-165. [PMID: 35338978 DOI: 10.1016/j.gaitpost.2022.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/20/2022] [Accepted: 03/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Idiopathic scoliosis does not only cause structural changes in the spine, but also functional changes of the musculoskeletal system. RESEARCH QUESTION Does idiopathic scoliosis lead to asymmetric hip loading in severe Lenke type 1 deformity? METHODS 23 patients (18 girls, 5 boys) aged 15 ± 2.8 years with an adolescent idiopathic main thoracic curve (Cobb angle 48.8°+/- 9.2°) were included. Measured X-ray parameters were: Cobb angle of primary thoracic and secondary lumbar curve, translation of the C7- plumb line, apical thoracic vertebra and apical lumbar vertebra from the central sacral vertical line. Subjects were examined by means of kinematic and kinetic gait analysis. The symmetry index (SI) was calculated as a ratio of hip frontal moments during a single stance for both sides when the symmetrical load was considered SI = 0 + /- 29.36 (0 +/- 1 SD of the mean SI of the healthy population). The Pearson correlation coefficient was used to show the relation between hip loading and radiologic measures of spinal deformity. RESULTS Only 34.8% of subjects with Lenke type 1 deformity showed symmetrical hip loading. Significant negative correlation was proved between SI and apical thoracic vertebra translation (R = - 0541; p < 0,05) as well as between SI and coronal imbalance (R = -0,5197; p < 0,05). There was no correlation between SI and the magnitude of the primary thoracic curve (R = -0.19; p = 0.385). Coronal imbalance correlates positively with translation of apical thoracic vertebra (R = 0,7255; p < 0,05). SIGNIFICANCE Two-thirds of subjects with Lenke type 1 deformity showed asymmetrical hip loading. This asymmetry is related to the translation of the apical thoracic vertebra and coronal imbalance and is not related to the magnitude of the main thoracic curve. On the contrary, the secondary lumbar curve plays role in the compensatory mechanism of the trunk.
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Affiliation(s)
- Jan Sklensky
- Department of Orthopaedic Surgery, University Hospital Brno, Brno, Czech Republic; Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Karel Urbasek
- Department of Paediatric Surgery, Orthopaedics, and Traumatology, University Hospital Brno, Brno, Czech Republic; Department of Paediatric Surgery, Orthopaedics and Traumatology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Martin Svehlik
- Department of Orthopaedics and Trauma - Section of Pediatric Orthopaedics, Medical University of Graz, Graz, Austria.
| | - Veronika Svozilova
- Department of Biomedical Engineering, Faculty of Electrical Engineering And Communication, Brno University of Technology, Brno, Czech Republic.
| | - Jan Kocanda
- Department of Orthopaedic Surgery, University Hospital Brno, Brno, Czech Republic; Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Martin Prymek
- Department of Orthopaedic Surgery, University Hospital Brno, Brno, Czech Republic; Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Robert Vyskocil
- Department of Orthopaedic Surgery, University Hospital Brno, Brno, Czech Republic; Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Martin Repko
- Department of Orthopaedic Surgery, University Hospital Brno, Brno, Czech Republic; Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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Tsaknakis K, Schmalz T, Freslier M, Tsaknakis B, Lorenz HM, Braunschweig L, Hell AK. Limited trunk motion and posterior pelvic tilting in ambulatory children treated with bilateral rib to pelvis implants for spinal deformity control. J Pediatr Orthop B 2022; 31:72-77. [PMID: 33720075 DOI: 10.1097/bpb.0000000000000858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In young children, growth-friendly spinal implants with bilateral rib to pelvis fixation are used to control progressive spinal deformity. Whereas curve progression, complications and side-effects have been extensively studied in this patient population, no data are available on gait pattern changes and postural body adjustments. Our study evaluates whether gait pattern changed for ambulatory children treated with bilateral rib to pelvis implants compared to age-matched healthy children. In this small cohort study, gait analysis was performed using spatiotemporal and kinematic parameters of four ambulatory children with severe scoliosis and growth-friendly spinal implants using the bilateral rib to pelvis fixation. Data were statistically analyzed and compared to seven healthy age-matched children. Between both groups, no differences were seen in walking speed, cadence and stride length. The treated patients showed a lower range of motion of the pelvic obliquity and of the trunk obliquity and rotation, but a higher knee flexion. Growth-friendly spinal implants with bilateral rib to pelvis fixation are commonly used in wheelchair children and rarely indicated in ambulatory patients. The presented data show reduced trunk and pelvis motion using this implant construct. These findings help to understand body postural adjustments and add valuable information for families and care providers when considering this surgery. Level of evidence: Therapeutic level IV.
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Affiliation(s)
- Konstantinos Tsaknakis
- Pediatric Orthopaedics, Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Goettingen
| | - Thomas Schmalz
- Gait Laboratory, Otto Bock SE&Co. KGaA, Clinical Research&Services/Biomechanics, Goettingen, Germany
| | - Marie Freslier
- Laboratory of Movement Analysis, University of Basel, University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Birgit Tsaknakis
- Pediatric Orthopaedics, Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Goettingen
| | - Heiko M Lorenz
- Pediatric Orthopaedics, Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Goettingen
| | - Lena Braunschweig
- Pediatric Orthopaedics, Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Goettingen
| | - Anna K Hell
- Pediatric Orthopaedics, Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Goettingen
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Holewijn RM, de Kleuver M, Kingma I, Keijsers NLW. A prospective analysis of motion and deformity at the shoulder level in surgically treated adolescent idiopathic scoliosis. Gait Posture 2019; 69:150-155. [PMID: 30721841 DOI: 10.1016/j.gaitpost.2019.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 12/11/2018] [Accepted: 01/18/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although posterior spinal correction and fusion surgery (PSF) of adolescent idiopathic scoliosis (AIS) limits counter rotation between thorax and pelvis, the physical function, and more specifically gait of these patients is only slightly affected after PSF. Possibly, shoulders-thorax counter-rotation increases to compensate for the loss in thorax-pelvis motion. This would subsequently result in a higher phase-difference and range of motion (ROM) between the shoulders and thorax. RESEARCH QUESTIONS What is the effect of PSF on the phase difference and ROM between the shoulders and thorax? What is the effect of PSF on upper body deformity? METHODS 18 AIS patients underwent gait analysis at increasing walking speeds (0.45 to 2.22 m/s) before, and 3 and 12 months after PSF. The phase difference, ROM, and deformity between the shoulders, thorax, and pelvis were calculated. RESULTS The shoulders- thorax phase difference was unaffected by surgery. At 3 months postoperatively the shoulders-thorax ROM was decreased (3.5° ± 0.2° versus 2.7° ± 0.2°, p=0.001). This recovered to preoperative values 12 months postoperatively (3.2° ± 0.2°, p=0.213). The shoulder-pelvis phase difference was decreased 3 months postoperatively (-98.9° ± 6.8° vs. -77.2° ± 7.2°, p=0.010), and recovered to pre-op values at the 12 months postoperative measurement (-89.6° ± 6.9°, p=0.290). Walking speed did not influence the effect of surgery on phase difference or ROM. The pre-operative shoulders-thorax asymmetry decreased from 3.4° ± 2.4° to 0.6° ± 3.1° (p<0.001). Shoulders-pelvis and thorax-pelvis asymmetry decreased from 10.0° ± 3.7° to 2.8° ± 4.3° (p<0.001) and from 6.5° ± 3.4° to 1.8° ± 3.2° (p=0.006) respectively. SIGNIFICANCE No compensatory mechanisms could be identified in the relative motion between the shoulders and the thorax. Possibly, compensatory mechanisms are not required for normal gait after surgery. The asymmetry of the shoulders in the transversal plane improved without specific surgical strategies.
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Affiliation(s)
- R M Holewijn
- Department of Orthopedic Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - M de Kleuver
- Department of Orthopedic Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - I Kingma
- Faculty of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorstraat 9, 1081 BT Amsterdam, the Netherlands
| | - N L W Keijsers
- Sint Maartenskliniek Research, Sint Maartenskliniek, Hengstdal 3, 6574 NA Ubburgen, the Netherlands
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Postural adjustments in adolescent idiopathic thoracic scoliosis during walking. Gait Posture 2019; 68:423-429. [PMID: 30594870 DOI: 10.1016/j.gaitpost.2018.12.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/15/2018] [Accepted: 12/17/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Adolescent idiopathic scoliosis (AIS) is the most common type of three-dimensional spinal deformity. Identifying the postural adjustments or changes for different phases and events is needed for developing programs to improve the AIS gait, but such information has been limited. The current study aimed to fill the gap via three-dimensional motion analysis of quiet standing and level walking in patients with severe thoracic AIS. MATERIALS AND METHODS Sixteen female adolescents with AIS (Lenke 1 or 2, age: 14.9 ± 1.7 years, height: 154.7 ± 5.0 cm, mass: 41.7 ± 7.2 kg) and sixteen sex-, age- and BMI-matched healthy controls (age: 14.8 ± 2.7 years, height: 154.9 ± 5.6 cm, mass: 44.7 ± 6.3 kg) participated in the current study with informed written consent. The kinematic and kinetic changes between the trunk, pelvis, and lower limb segments, and at the lumbosacral level at different gait events were measured during quiet standing and level walking. RESULTS The homogeneity of the current patient group helped reduce the effects of the level and severity of spinal deformity on inter-subject variability that has been associated with controversies over reported gait variables in AIS. The current results support the hypothesis that postural adjustments involving the trunk, pelvis and lower limb segments were needed in severe thoracic AIS during both quiet standing and level walking, and differed between concave and convex sides at different key gait events during level walking. CONCLUSIONS Although scoliotic spinal deformity occurred mainly in the frontal plane, postural adjustments in all three planes were present at key events during level walking with associated joint loading changes in patients with severe thoracic AIS. Monitoring of such adjustments and the associated joint kinetic changes will be helpful for assessing the disease and treatment outcomes.
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Spinal correction surgery improves asymmetrical trunk kinematics during gait in adolescent idiopathic scoliosis with thoracic major curve. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 28:619-626. [PMID: 30145657 DOI: 10.1007/s00586-018-5741-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/19/2018] [Accepted: 08/17/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To clarify the effect of posterior correction and fusion surgery on the trunk-pelvic kinematics during gait in adolescent idiopathic scoliosis (AIS) patients with single thoracic major curve. METHODS Among preoperative AIS patients who planned correction surgery, 18 patients with Lenke type 1A or B were selected for this study. All patients were female. The patients' trunk and pelvic kinematics during gait were measured three-dimensionally and dynamically using reflective markers, optoelectronic motion capture system. The gait analysis was performed before and 1-2 years after surgery. The trunk and pelvic symmetry during gait was evaluated at coronal, sagittal, and transverse planes between concave and convex sides. RESULTS The trunk and pelvic angles in sagittal and coronal planes were equivalent between concave and convex sides before and after surgery. Preoperatively, transverse trunk rotation angles were significantly deviated toward the concave (left) side during both static standing (4.3 ± 2.0°) and gait (8.8 ± 0.6°, p < 0.01). Preoperative transverse pelvic rotation angles were significantly deviated toward the convex side during static standing (4.0 ± 3.8°). However, pelvis displayed with symmetric rotational kinematics during gait. Postoperatively, the deviated transverse trunk rotation angle significantly decreased (1.6 ± 0.3°), and the transverse rotational kinematics of both trunk and pelvis improved to symmetric. CONCLUSIONS Posterior correction and fusion surgery have improved preoperative asymmetric global rotational kinematics of trunk and pelvis in transverse plane to symmetric postoperatively in AIS patients with thoracic single major curve. These slides can be retrieved under Electronic Supplementary Material.
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