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Ohlendorf D, Schlegel C, Oremek GM, Holzgreve F, Wanke EM, Mauer-Grubinger C, Diaremes P, Hülstrunk C, Zabar O, Groneberg DA. No effects of four weeks of combined brace and Schroth therapy in moderate adolescent idiopathic scoliosis on plantar pressure distribution. BMC Musculoskelet Disord 2024; 25:728. [PMID: 39261824 PMCID: PMC11389353 DOI: 10.1186/s12891-024-07841-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 09/02/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Positive effects of brace treatments in adolescent idiopathic scoliosis patients on gait were proven. AIM Therefore, this study examined whether the influence of brace therapy in combination with Schroth therapy influencing the plantar pressure distribution, pre and post intensive rehabilitative inpatient treatment. DESIGN Prospective cohort study, longitudinal. SETTING Scoliosis rehabilitation clinic "Asklepios Katharina-Schroth-Klinik" (Bad Sobernheim, Germany). POPULATION Twenty (14f/6m) patients (12-16 years) had a medically diagnosed moderate idiopathic scoliosis (Cobb angle 20-50°, Median 30°) and an indication for combined brace and Schroth therapy with an inpatient stay (4 weeks) at the Asklepios Katharina Schroth Clinic (Germany). METHODS At the beginning (T1) and at the end of the stay (T2), the plantar pressure distribution with (A) and without wearing a brace (B) was recorded (walking distance 10 m). RESULTS No significant differences between the left and right foot were found at baseline (T1). The T1 - T2 comparison of one foot revealed significant differences (p ≤ 0.05 - 0.001, respectively) for (A): mean pressure right midfoot, loaded area total left foot, left midfoot, left inner ball of foot, right midfoot, impulse total right foot, right midfoot and for (B): mean pressure right midfoot, right outer ball of foot, loaded area total right foot, right heel, right midfoot, impulse right heel, right midfoot, right outer ball of foot. CONCLUSIONS A combined brace and Schroth therapy maintains the initial symmetrical plantar pressure distribution over the duration of four weeks since the significant differences fall within the range of measurement error. CLINICAL REHABILITATION IMPACT The insole measuring system can be used to objectively support therapeutic gait training as part of rehabilitation and to assess insole fitting based on foot shape. Due to its convenient handling and rapid data acquisition, it may be a suitable method for interim or follow-up diagnostics in the treatment of idiopathic scoliosis.
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Affiliation(s)
- Daniela Ohlendorf
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9a, 60596, Frankfurt/Main, Germany.
| | - Christian Schlegel
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9a, 60596, Frankfurt/Main, Germany
| | - Gerhard M Oremek
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9a, 60596, Frankfurt/Main, Germany
| | - Fabian Holzgreve
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9a, 60596, Frankfurt/Main, Germany
| | - Eileen M Wanke
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9a, 60596, Frankfurt/Main, Germany
| | - Christian Mauer-Grubinger
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9a, 60596, Frankfurt/Main, Germany
| | - Panagiotis Diaremes
- Clinic for Trauma Surgery, Orthopedics University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | | | - Omar Zabar
- Katharina-Schroth-Clinic, 55566, Bad Sobernheim, Germany
| | - David A Groneberg
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9a, 60596, Frankfurt/Main, Germany
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Huysmans SM, Senden R, Jacobs E, Willems PJ, Marcellis RG, Boogaart MVD, Meijer K, Willems PC. Gait alterations in patients with adult spinal deformity. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 17:100306. [PMID: 38293567 PMCID: PMC10825775 DOI: 10.1016/j.xnsj.2023.100306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 02/01/2024]
Abstract
Background Adult spinal deformity patients (ASD) experience altered spinal alignment affecting spatiotemporal parameters and joint kinematics. Differences in spinal deformity between patients with symptomatic idiopathic scoliosis (ID-ASD) and patients with "de novo" scoliosis (DN-ASD) may affect gait characteristics differently. This study aims to compare gait characteristics between ID-ASD, DN-ASD, and asymptomatic healthy matched controls. Methods In this observational case-control study, ID-ASD (n = 24) and DN-ASD (n = 26) patients visiting the out-patient spine clinic and scheduled for long-segment spinal fusion were included. Patients were matched, based on age, gender, leg length and BMI, with asymptomatic healthy controls. Gait was measured at comfortable walking speed on an instrumented treadmill with 3D motion capture system. Trunk, pelvic and lower extremities range of motion (ROM) and spatiotemporal parameters (SPT) are presented as median (first and thirds quartile). Independent t-test or Mann-Whitney U test was used to compare ID-ASD, DN-ASD and controls. Statistical Parametric Mapping (independent t-test) was used to compare 3D joint kinematics. Results DN-ASD patients walk with increased anterior trunk tilt during the whole gait cycle compared with ID-ASD patients and controls. ID-ASD walk with decreased trunk lateroflexion compared with DN-ASD and controls. DN-ASD showed decreased pelvic obliquity and -rotation, increased knee flexion, and decreased ankle plantar flexion. ID-ASD and DN-ASD displayed decreased trunk, pelvic and lower extremity ROM compared with controls, but increased pelvic tilt ROM. ID-ASD patients walked with comparable SPT to controls, whereas DN-ASD patients walked significantly slower with corresponding changes in SPT and wider steps. Conclusions DN-ASD patients exhibit distinct alterations in SPT and kinematic gait characteristics compared with ID-ASD and controls. These alterations seem to be predominantly influenced by sagittal spinal malalignment and kinematic findings in ASD patients should not be generalized as such, but always be interpreted with consideration for the nature of the ASD.
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Affiliation(s)
- Stephanie M.D. Huysmans
- Department of Orthopedic Surgery and Research School CAPHRI (Care and Public Health Research Institute), Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
| | - Rachel Senden
- Department of Physiotherapy, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
| | - Eva Jacobs
- Department of Orthopedic Surgery and Research School CAPHRI (Care and Public Health Research Institute), Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
| | - Paul J.B. Willems
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism (MUMC+), the Netherlands
| | - Rik G.J. Marcellis
- Department of Physiotherapy, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
| | - Mark van den Boogaart
- Department of Orthopedic Surgery and Research School CAPHRI (Care and Public Health Research Institute), Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism (MUMC+), the Netherlands
| | - Paul C. Willems
- Department of Orthopedic Surgery and Research School CAPHRI (Care and Public Health Research Institute), Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
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Ji R, Liu X, Liu Y, Yan B, Yang J, Lee WYW, Wang L, Tao C, Kuai S, Fan Y. Kinematic difference and asymmetries during level walking in adolescent patients with different types of mild scoliosis. Biomed Eng Online 2024; 23:22. [PMID: 38369455 PMCID: PMC10875845 DOI: 10.1186/s12938-024-01211-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/22/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS), three-dimensional spine deformation, affects body motion. Previous research had indicated pathological gait patterns of AIS. However, the impact of the curve number on the walking mechanism has not been established. Therefore, this study aimed to compare the gait symmetry and kinematics in AIS patients with different curve numbers to healthy control. RESULTS In the spinal region, double curves AIS patients demonstrated a smaller sagittal symmetry angle (SA) and larger sagittal convex ROM of the trunk and lower spine than the control group. In the lower extremities, the single curve patients showed a significantly reduced SA of the knee joint in the frontal plane, while the double curves patients showed a significantly reduced SA of the hip in the transverse plane. CONCLUSION The curve number indeed affects gait symmetry and kinematics in AIS patients. The double curves patients seemed to adopt a more "careful walking" strategy to compensate for the effect of spinal deformation on sensory integration deficits. This compensation mainly occurred in the sagittal plane. Compared to double curves patients, single curve patients unitized a similar walking strategy with healthy subjects.
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Affiliation(s)
- Run Ji
- School of Biological Science and Medical Engineering, School of Engineering Medicine, Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, 100191, China
- Institute of Biomechanics, National Research Center for Rehabilitation Technical Aids, Beijing, 100176, China
| | - Xiaona Liu
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, 100084, China
| | - Yang Liu
- Shenzhen Youth Spine Health Center, Shenzhen, 518035, China
| | - Bin Yan
- Department of Spine Surgery, Shenzhen Second People's Hospital, Shenzhen, 518039, China
- Department of Spine Surgery, First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, China
- Shenzhen University School of Medicine, Shenzhen, 518060, China
- Shenzhen Youth Spine Health Center, Shenzhen, 518035, China
| | - Jiemeng Yang
- School of Biological Science and Medical Engineering, School of Engineering Medicine, Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, 100191, China
- Institute of Biomechanics, National Research Center for Rehabilitation Technical Aids, Beijing, 100176, China
| | - Wayne Yuk-Wai Lee
- Department of Orthopedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Ling Wang
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, 300384, China
- National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Chunjing Tao
- School of Biological Science and Medical Engineering, School of Engineering Medicine, Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, 100191, China.
| | - Shengzheng Kuai
- Department of Spine Surgery, Shenzhen Second People's Hospital, Shenzhen, 518039, China.
- Department of Spine Surgery, First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, China.
- Shenzhen University School of Medicine, Shenzhen, 518060, China.
- Shenzhen Youth Spine Health Center, Shenzhen, 518035, China.
| | - Yubo Fan
- School of Biological Science and Medical Engineering, School of Engineering Medicine, Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, 100191, China.
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Samadi B, Raison M, Mahaudens P, Detrembleur C, Achiche S. A preliminary study in classification of the severity of spine deformation in adolescents with lumbar/thoracolumbar idiopathic scoliosis using machine learning algorithms based on lumbosacral joint efforts during gait. Comput Methods Biomech Biomed Engin 2023; 26:1341-1352. [PMID: 36093771 DOI: 10.1080/10255842.2022.2117547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/07/2022] [Accepted: 08/22/2022] [Indexed: 11/03/2022]
Abstract
To assess the severity and progression of adolescents with idiopathic scoliosis (AIS), radiography with X-rays is usually used. The methods based on statistical observations have been developed from 3D reconstruction of the trunk or topography. Machine learning has shown great potential to classify the severity of scoliosis on imaging data, generally on X-ray measurements. It is also known that AIS leads to the development of gait disorder. To our knowledge, machine learning has never been tested on spine intervertebral efforts during gait as a radiation-free method to classify the severity of spinal deformity in AIS. Develop automated machine learning algorithms in lumbar/thoracolumbar scoliosis to classify the severity of spinal deformity of AIS based on the lumbosacral joint (L5-S1) efforts during gait. The lumbosacral joint efforts of 30 individuals with lumbar/thoracolumbar AIS were used as distinctive features fed to the machine learning algorithms. Several tests were run using various classification algorithms. The labeling consisted of three classes reflecting the severity of scoliosis i.e. mild, moderate and severe. The ensemble classifier algorithm including k-nearest neighbors, support vector machine, random forest and multilayer perceptron achieved the most promising results, with accuracy scores of 91.4%. This preliminary study shows lumbosacral joint efforts can be used to classify the severity of spinal deformity in lumbar/thoracolumbar AIS. This method showed the potential of being used as an assessment tool to follow-up the progression of AIS as a radiation-free method, alternative to radiography. Future studies should be performed to test the method on other categories of AIS.
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Affiliation(s)
- Bahare Samadi
- Department of Mechanical Engineering, Polytechnique Montréal, Montreal, QC, Canada
- Technopole in Pediatric Rehabilitation Engineering, Sainte-Justine UHC, Montreal, Canada
| | - Maxime Raison
- Department of Mechanical Engineering, Polytechnique Montréal, Montreal, QC, Canada
- Technopole in Pediatric Rehabilitation Engineering, Sainte-Justine UHC, Montreal, Canada
| | - Philippe Mahaudens
- Service d'orthopédie et de traumatologie de l'appareil locomoteur, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Université catholique de Louvain, Brussels, Belgium
| | - Christine Detrembleur
- Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Université catholique de Louvain, Brussels, Belgium
| | - Sofiane Achiche
- Department of Mechanical Engineering, Polytechnique Montréal, Montreal, QC, Canada
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Morimoto T, Yamamoto Y, Suzuki S, Yagi M, Kobayashi T, Mawatari M, Matsumoto M, Watanabe K. Analysis of the sacroiliac joint vacuum phenomenon in adolescent thoracic idiopathic scoliosis (Lenke types 1 and 2). Medicine (Baltimore) 2023; 102:e34487. [PMID: 37653771 PMCID: PMC10470709 DOI: 10.1097/md.0000000000034487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/19/2023] [Accepted: 06/28/2023] [Indexed: 09/02/2023] Open
Abstract
The sacroiliac joint (SIJ) is the largest axial joint in the human body, and the SIJ vacuum phenomenon (SIJ VP) is a common finding in computed tomography studies of the abdomen, pelvis, and lumbosacral spine in adults, with the incidence increasing with age. Adolescent idiopathic scoliosis (AIS) is an abnormal spinal curvature that appears during adolescence and places abnormal stress on the SIJs. This retrospective observational study aimed to investigate the incidence of the SIJ VP in thoracic AIS (Lenke types 1 and 2). Sixty-seven patients with AIS (age: 12-19 years) and 76 controls (age: 11-19 years) were retrospectively analyzed to investigate SIJ VP, subchondral bone cysts, and SIJ degeneration (Eno classification: type 0, no degenerative change; type 1, mild degenerative changes; type 2, substantial degenerative changes; and type 3, ankylosis). SIJ degeneration was defined as type ≥ 2. The association between SIJ VP, cysts, SIJ degeneration, and sagittal/coronal spinopelvic alignment was assessed. SIJ VP (59% vs. 35.5%, P < .01), cysts (32.8% vs. 1.3%, P < .01), and SIJ degeneration (3.2% vs. 2.6%, P = .823) differed significantly between the 2 groups. There were 0 cases of SIJ ankylosis (Eno classification type 3) in both groups. The VP was not correlated with lumbar lordosis, sacral slope, or Cobb angle. All lumbar modifier type C belonged to the VP present group, whereas none to VP absent group. Our results suggest an association between AIS and SIJ VP and SIJ cysts. SIJ VP and SIJ cysts in AIS may be caused and accelerated by abnormal mechanical stress on SIJ due to spinal deformity.
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Affiliation(s)
- Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Yusuke Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Nara Medical University, Nara, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Faculty of Medicine, Nara Medical University, Nara, Japan
| | - Takaomi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Boulcourt S, Badel A, Pionnier R, Neder Y, Ilharreborde B, Simon AL. A gait functional classification of adolescent idiopathic scoliosis (AIS) based on spatio-temporal parameters (STP). Gait Posture 2023; 102:50-55. [PMID: 36905785 DOI: 10.1016/j.gaitpost.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/04/2023] [Accepted: 03/06/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Therapeutic decisions for patients with adolescent idiopathic scoliosis (AIS) are mostly based on static measurements performed on two-dimensional standing full-spine radiographs. However, the trunk plays an essential role in the human locomotion, and the functional consequences during daily activities of this specific and common spinal deformity are not factored in. RESEARCH QUESTION Does patients with AIS have specific gait patterns based on spatio-temporals parameters measurements ? METHODS 90 AIS patients (aged 10-18 years) with preoperative simplified gait analysis were retrospectively included for analysis between 2017 and 2020. Spatio-temporal parameters (STP) were measured on a 3-m baropodometric gaitway and included the measurement of 15 normalized gait parameters. A hierarchical cluster analysis was performed to identify group of patients based on the similarities of their gait patterns, and functional variables' inter-group differences were also measured. The subject distribution was calculated to identify the structural characteristics of the subjects according to their gait patterns. RESULTS Three gait patterns were identified. Cluster 1 (46%) was defined by asymmetry, Cluster 2 (16%) by instability, and Cluster 3 (36%) by variability. Each cluster was significantly different from the other ones on at least 6 different parameters (p < 0.05). Furthermore, each cluster was associated with one type of curve: Lenke 1 for Cluster 1 (57.5%), Lenke 6 for Cluster 2 (40%) and Lenke 5 for Cluster 3 (43.5%). SIGNIFICANCE Patients with severe AIS have a dynamic signature during gait identified on STP. Understanding consequences of this deformity on gait may be an interesting avenue to study the pathological mechanisms involved in their dynamic motor organization. Furthermore, these results might also be a first step to study the effectiveness of the different therapies.
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Affiliation(s)
- Sarah Boulcourt
- Plateforme d'Analyse de la Marche (PAM), Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Anne Badel
- Unité de Biologie Fonctionnelle et Adaptative (BFA), UMR 8251, CNRS, ERL 1133, Inserm, Paris, France; Université Paris Cité, Paris, France
| | - Raphaël Pionnier
- Unité Fonctionnelle d'Analyse du Mouvement (UFAM), Hôpitaux Nationaux de Saint-Maurice, Saint-Maurice, France
| | - Yamile Neder
- Plateforme d'Analyse de la Marche (PAM), Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France; Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Brice Ilharreborde
- Université Paris Cité, Paris, France; Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Anne-Laure Simon
- Plateforme d'Analyse de la Marche (PAM), Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France; Université Paris Cité, Paris, France; Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
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Gómez Cristancho DC, Jovel Trujillo G, Manrique IF, Pérez Rodríguez JC, Díaz Orduz RC, Berbeo Calderón ME. Neurological mechanisms involved in idiopathic scoliosis. Systematic review of the literature. NEUROCIRUGIA (ENGLISH EDITION) 2023; 34:1-11. [PMID: 35256329 DOI: 10.1016/j.neucie.2022.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 02/01/2023]
Abstract
The literature that explains the neurological mechanisms underlying the development or compensation of idiopathic scoliosis is limited. The objective of the article is to describe and integrate the mechanisms and nerve pathways through which idiopathic scoliosis is compensated and/or developed. A narrative systematic review in different databases of the studies published between January 1, 1967 and April 1, 2021 was performed, using the following terms: "scoliosis", "vision", "eye", "vestibule", "labyrinth" "posture", "balance", "eye movements", "cerebellum", "proprioception", and "physiological adaptation". In the search, 1112 references were identified, of which 50 were finally included: 46 observational analytical clinical studies-descriptive (between cohorts, report and series of cases) and 4 experimental studies. In the neurological response to idiopathic scoliosis, the sensory-cortical integration of the afferences in the visual-oculomotor-vestibular-proprioceptive systems, allows modifications at the postural level in order to achieve an initial compensation on the sagittal balance and the centre of body mass; however, over time these compensation mechanisms may be exhausted causing progression of the initial deformity.
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Affiliation(s)
- David Camilo Gómez Cristancho
- Médico General, Miembro Semillero Neurología y Neurocirugía, Pontificia Universidad Javeriana-Hospital Universitario San Ignacio, Bogotá, Colombia.
| | - Gabriela Jovel Trujillo
- Estudiante de Medicina, Miembro Semillero Neurología y Neurocirugía, Pontificia Universidad Javeriana-Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Iván Felipe Manrique
- Estudiante de Medicina, Miembro Semillero Neurología y Neurocirugía, Pontificia Universidad Javeriana-Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Roberto Carlos Díaz Orduz
- Médico Neurocirujano, Pontificia Universidad Javeriana-Hospital Universitario San Ignacio, Bogotá, Colombia
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The effect of vertebral body tethering on spine range of motion in adolescent idiopathic scoliosis: a pilot study. Spine Deform 2023; 11:123-131. [PMID: 36114988 DOI: 10.1007/s43390-022-00578-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/21/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Posterior spinal fusion and instrumentation (PSF) and vertebral body tethering (VBT) are corrective surgical techniques used in treating adolescent idiopathic scoliosis (AIS). Comparing the preservation of spine range of motion (ROM) following PSF and VBT for treatment of AIS has yet to be explored. The purpose of this work was to retrospectively compare global spine ROM in adolescents (9-18 years of age) without spine deformity, adolescents with untreated AIS, adolescents having undergone PSF, and adolescents having undergone VBT to gain insight on the effect of VBT on spine motion. METHODS Twenty participants were recruited into four groups including Control (n = 6), untreated AIS (n = 5), post-operative PSF (n = 4) and post-operative VBT (n = 5). Three-dimensional kinematics of the spine were collected and analyzed using an intersegmental spine model during constrained forward flexion, right-left lateral bending, and right-left axial twist movements. RESULTS The PSF group displayed significantly lower spine ROM than the two non-operative groups during thoracic and total left axial twist (p ≤ 0.048), whereas thoracic and total ROM during right-left lateral bending is almost equally lower in the PSF (p ≤ 0.03) and VBT (p ≤ 0.01) groups when compared to the Control and AIS groups. CONCLUSION These results suggest some preservation of spine motion in the transverse plane following VBT. This study provides initial evidence of some potential preservation of spine ROM following VBT; however, further prospective investigation of VBT is needed to assess and confirm these hypotheses.
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Pesenti S, Prost S, Pomero V, Authier G, Severyns M, Roscigni L, Boulay C, Blondel B, Jouve JL. Early dynamic changes within the spine following posterior fusion using hybrid instrumentation in adolescents with idiopathic scoliosis: a gait analysis study. Arch Orthop Trauma Surg 2022; 142:3613-3621. [PMID: 34008049 DOI: 10.1007/s00402-021-03956-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/07/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION In adolescent idiopathic scoliosis (AIS) patients, mechanical consequences of posterior spinal fusion within the spine remain unclear. Through dynamic assessment, gait analysis could help elucidating this particular point. The aim of this study was to describe early changes within the spine following fusion with hybrid instrumentation in adolescents with idiopathic scoliosis, using gait analysis MATERIALS AND METHODS: We conducted a single-centre prospective study including AIS patients scheduled for posterior spinal fusion (PSF) using hybrid instrumentation with sublaminar bands. Patients underwent radiographic and gait analyses preoperatively and during early postoperative period. Among gait parameters, motion of cervicothoracic, thoracolumbar and lumbosacral junctions was measured in the three planes. RESULTS We included 55 patients (mean age 15 years, 84% girls). Fusion was performed on 12 levels and mean follow-up was 8 months. There was a moderately strong correlation between thoracolumbar sagittal motion and lumbosacral junction pre- and postoperatively (R = - 0.6413 and R = - 0.7040, respectively, all p < 0.001), meaning that the more thoracolumbar junction was in extension, the more lumbosacral extension movements decreased. There was a trend to significance between postoperative SVA change and thoracolumbar sagittal motion change (R = - 0.2550, p = 0.059). DISCUSSION This is the first series reporting dynamic changes within the spine following PSF using hybrid instrumentation in AIS patients. PSF led to symmetrization of gait pattern. In the sagittal plane, we found that thoracolumbar extension within the fused area led to decreased extension at cervicothoracic and lumbosacral junctions. Even though consequences of such phenomenon are unclear, attention must be paid not to give a too posterior alignment when performing PSF for AIS patients.
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Affiliation(s)
- Sébastien Pesenti
- Pediatric Orthopedics, Timone Enfants, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France.
- Gait Analysis Laboratory, Timone, Aix Marseille University, Marseille, France.
- Orthopédie Infantile, CNRS, ISM, Aix-Marseille Université, Hôpital de La Timone, AP-HM, Marseille, France.
| | - Solene Prost
- Pediatric Orthopedics, Timone Enfants, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
- Gait Analysis Laboratory, Timone, Aix Marseille University, Marseille, France
- Orthopédie Infantile, CNRS, ISM, Aix-Marseille Université, Hôpital de La Timone, AP-HM, Marseille, France
| | - Vincent Pomero
- Gait Analysis Laboratory, Timone, Aix Marseille University, Marseille, France
| | - Guillaume Authier
- Gait Analysis Laboratory, Timone, Aix Marseille University, Marseille, France
| | - Matthieu Severyns
- Pediatric Orthopedics, Timone Enfants, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
| | - Lionel Roscigni
- Pediatric Orthopedics, Timone Enfants, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
- Gait Analysis Laboratory, Timone, Aix Marseille University, Marseille, France
| | - Christophe Boulay
- Pediatric Orthopedics, Timone Enfants, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
- Gait Analysis Laboratory, Timone, Aix Marseille University, Marseille, France
- Orthopédie Infantile, CNRS, ISM, Aix-Marseille Université, Hôpital de La Timone, AP-HM, Marseille, France
| | - Benjamin Blondel
- Pediatric Orthopedics, Timone Enfants, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
- Gait Analysis Laboratory, Timone, Aix Marseille University, Marseille, France
- Orthopédie Infantile, CNRS, ISM, Aix-Marseille Université, Hôpital de La Timone, AP-HM, Marseille, France
| | - Jean-Luc Jouve
- Pediatric Orthopedics, Timone Enfants, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
- Gait Analysis Laboratory, Timone, Aix Marseille University, Marseille, France
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10
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da Silveira GE, Andrade RM, Guilhermino GG, Schmidt AV, Neves LM, Ribeiro AP. The Effects of Short- and Long-Term Spinal Brace Use with and without Exercise on Spine, Balance, and Gait in Adolescents with Idiopathic Scoliosis. Medicina (B Aires) 2022; 58:medicina58081024. [PMID: 36013490 PMCID: PMC9413676 DOI: 10.3390/medicina58081024] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Adolescent idiopathic scoliosis (AIS) is a prevalent spinal disorder in adolescents. Previous studies have shown biomechanical changes of the gait in the lower limb of AIS patients. To minimize the progression of scoliotic curvature, a spinal brace is used, which has been shown to be efficient. Usually, a brace is worn strictly for 20–22 h every day. To our knowledge, no study has assessed the short- and long-term effects of spinal brace use with or without an exercise program (6 months) to improve clinical and biomechanical parameters. The aim of our study was to verify the effects of short- and long-term spinal brace use, with or without an exercise program on the spine, body balance, and plantar load distribution during gait in AIS. Materials and Methods: A prospective randomized study was conducted with intention-to-treat analysis in forty-five adolescents diagnosed with AIS undergoing conservative treatment at a center specialized in spinal rehabilitation. Adolescents were evaluated at two stages of intervention: (1) spinal orthopedic brace, with acute use 24 h/day (n = 22) and (2) spinal orthopedic brace, with acute use between 15–18 h/day associated with a specific rehabilitation exercise protocol for six consecutive months (six months and 12 total sessions, n = 23). The evaluated parameters were: spine pain, using a visual analog scale (VAS); Cobb angle measurement using radiograph exams, as well as the Risser sign; and static balance and plantar pressure of the feet during gait, carried out using a pressure platform. Results: AIS patients showed significant improvements in the main scoliotic curvature, with a 12-degree reduction in Cobb angle pre- and post-short-term immediate use of spinal brace and a 5.3 degree correction after six months of spinal brace use in combination with specific exercises (long term). In addition, short- and long-term brace use with an exercise program showed a significant increase in anteroposterior and mediolateral balance and a reduction in plantar overload on the heel during gait, with an effect size between moderate and high. Conclusions: Intervention via the short- or long-term use of a spinal brace combined with specific exercises in adolescents with idiopathic scoliosis proved to be effective for correcting scoliotic curvature. In addition, intervention also showed improvements to the antero-posterior and mediolateral body balance and a reduction in the plantar load on the rearfoot region during gait, demonstrating effective mechanical action on the spine.
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Affiliation(s)
- Guilherme Erdmann da Silveira
- Biomechanics and Musculoskeletal Rehabilitation Laboratory, Health Science Post-Graduate Department, Medicine School, University Santo Amaro, São Paulo 04829-300, SP, Brazil; (G.E.d.S.); (A.V.S.); (L.M.N.)
| | | | | | - Ariane Verttú Schmidt
- Biomechanics and Musculoskeletal Rehabilitation Laboratory, Health Science Post-Graduate Department, Medicine School, University Santo Amaro, São Paulo 04829-300, SP, Brazil; (G.E.d.S.); (A.V.S.); (L.M.N.)
| | - Lucas Melo Neves
- Biomechanics and Musculoskeletal Rehabilitation Laboratory, Health Science Post-Graduate Department, Medicine School, University Santo Amaro, São Paulo 04829-300, SP, Brazil; (G.E.d.S.); (A.V.S.); (L.M.N.)
- Department of Psychiatry, University of Sao Paulo, São Paulo 01246-903, SP, Brazil
| | - Ana Paula Ribeiro
- Biomechanics and Musculoskeletal Rehabilitation Laboratory, Health Science Post-Graduate Department, Medicine School, University Santo Amaro, São Paulo 04829-300, SP, Brazil; (G.E.d.S.); (A.V.S.); (L.M.N.)
- Physical Therapy Department, School of Medicine, University of São Paulo, São Paulo 01246-903, SP, Brazil
- Correspondence: ; Tel.: +55-11-99139-2168
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11
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Mecanismos neurológicos involucrados en la escoliosis idiopática. Revisión sistemática de la literatura. Neurocirugia (Astur) 2022. [DOI: 10.1016/j.neucir.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Yurt Y, Yatar İ, Malkoç M, Tüzün EH, Mıhçıoğlu S, Ercan Y. Gait oxygen consumption in adolescent idiopathic scoliosis and the effect of brace use. Gait Posture 2020; 81:91-95. [PMID: 32702627 DOI: 10.1016/j.gaitpost.2020.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/16/2020] [Accepted: 07/15/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite studies showing that gait is affected in adolescent idiopathic scoliosis (AIS), it remains unclear whether gait oxygen consumption is altered. RESEARCH QUESTION The aims of the present study were to compare energy consumption during gait between subjects with AIS and healthy controls, and to examine the effect of brace use on gait energy expenditure. METHODS This prospectively designed study included 15 AIS and 15 healthy girls, whose ages ranged from 10 to 16 years old and Cobb angles from 20 and 45°. At the end of the first month of brace use for the first time in individuals with AIS, oxygen consumption was measured with and without brace use on a treadmill at a gait speed of 4 km.h-1 using a metabolic analyzer. RESULTS There was no statistically significant difference in gross and net gait oxygen consumption measurements between AIS and healthy individuals or between individuals with AIS with or without brace use (p > 0.05). SIGNIFICANCE After one month of brace treatment, AIS is not associated with an additional metabolic load with or without the brace during gait when compared to healthy subjects.
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Affiliation(s)
- Yasin Yurt
- Eastern Mediterranean University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Mersin 10, Turkey.
| | - İlker Yatar
- Eastern Mediterranean University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Mersin 10, Turkey.
| | - Mehtap Malkoç
- Eastern Mediterranean University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Mersin 10, Turkey.
| | - Emine Handan Tüzün
- Eastern Mediterranean University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Mersin 10, Turkey.
| | - Serpil Mıhçıoğlu
- Eastern Mediterranean University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Mersin 10, Turkey.
| | - Yasemin Ercan
- Eastern Mediterranean University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Mersin 10, Turkey.
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Pesenti S, Pomero V, Prost S, Severyns M, Authier G, Roscigni L, Viehweger E, Blondel B, Jouve JL. Curve location influences spinal balance in coronal and sagittal planes but not transversal trunk motion in adolescents with idiopathic scoliosis: a prospective observational study. 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 2020; 29:1972-1980. [PMID: 32140786 DOI: 10.1007/s00586-020-06361-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 01/13/2020] [Accepted: 02/26/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE In adolescent idiopathic scoliosis (AIS), spinal deformity can be seen in the thoracic or in the lumbar area. Although differences according to curve location are well described on standard radiographs, dynamic consequences of such difference remain unclear. Our objective was to explore the differences in dynamic spinal balance according to curve location in AIS patients using gait analysis METHODS: We prospectively included 22 females with AIS planned for surgical correction (16.3 years old, 81% Risser ≥ 4). Patients were divided into two matched cohorts, according to major curve location [right thoracic (Lenke 1) or left lumbar (Lenke 5)]. Gait analysis was performed the day before surgery. Global balance was analyzed as the primary outcome. Local curves parameters (dynamic Cobb angles) were defined as the secondary outcome. RESULTS In coronal plane, Lenke 5 patients had a left trunk shift, whereas trunk was shifted to the right in Lenke 1 patients (- 20.7 vs 6.3, p = 0.001). In the sagittal plane, the main difference between the two groups was T12 position that remained over the pelvis during gait in Lenke 5 patients, whereas it was anterior to the pelvis in Lenke 1 patients. In the transversal plane, Lenke 5 and Lenke 1 patients presented the same gait abnormalities, with a global trunk rotation to the left (- 4.8 vs - 7.6, p = 0,165). CONCLUSION This is the first study to provide the results of a direct comparison between Lenke 1 and Lenke 5 patients during gait. Curve location influenced coronal and sagittal balance, but abnormalities of transversal trunk motion were the same, wherever the curve was located. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Sébastien Pesenti
- Paediatric Orthopaedics, Hôpital D'enfants de La Timone, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France.
- Gait Analysis Platform, Timone, Aix-Marseille University, Marseille, France.
- Orthopédie pédiatrique, APHM, CNRS, ISM, Hôpital de La Timone, Aix Marseille Univ, Marseille, France.
| | - Vincent Pomero
- Gait Analysis Platform, Timone, Aix-Marseille University, Marseille, France
| | - Solène Prost
- Paediatric Orthopaedics, Hôpital D'enfants de La Timone, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
- Gait Analysis Platform, Timone, Aix-Marseille University, Marseille, France
- Orthopédie pédiatrique, APHM, CNRS, ISM, Hôpital de La Timone, Aix Marseille Univ, Marseille, France
| | - Mathieu Severyns
- Paediatric Orthopaedics, Hôpital D'enfants de La Timone, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
| | - Guillaume Authier
- Gait Analysis Platform, Timone, Aix-Marseille University, Marseille, France
| | - Lionel Roscigni
- Paediatric Orthopaedics, Hôpital D'enfants de La Timone, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
- Gait Analysis Platform, Timone, Aix-Marseille University, Marseille, France
- Orthopédie pédiatrique, APHM, CNRS, ISM, Hôpital de La Timone, Aix Marseille Univ, Marseille, France
| | - Elke Viehweger
- Paediatric Orthopaedics, Hôpital D'enfants de La Timone, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
- Gait Analysis Platform, Timone, Aix-Marseille University, Marseille, France
- Orthopédie pédiatrique, APHM, CNRS, ISM, Hôpital de La Timone, Aix Marseille Univ, Marseille, France
| | - Benjamin Blondel
- Paediatric Orthopaedics, Hôpital D'enfants de La Timone, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
- Gait Analysis Platform, Timone, Aix-Marseille University, Marseille, France
- Orthopédie pédiatrique, APHM, CNRS, ISM, Hôpital de La Timone, Aix Marseille Univ, Marseille, France
| | - Jean Luc Jouve
- Paediatric Orthopaedics, Hôpital D'enfants de La Timone, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
- Gait Analysis Platform, Timone, Aix-Marseille University, Marseille, France
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Pesenti S, Prost S, Pomero V, Authier G, Severyns M, Viehweger E, Blondel B, Jouve JL. Characterization of trunk motion in adolescents with right thoracic idiopathic scoliosis. 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 2019; 28:2025-2033. [PMID: 31317309 DOI: 10.1007/s00586-019-06067-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/02/2019] [Accepted: 07/12/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although standard radiography is currently used for deformity assessment in AIS patients, it is performed in a constrained position and probably not reflective of spinal balance during daily-life activities. Our main objective was to compare trunk motion in Lenke 1 and 2 AIS patients to healthy volunteers, using gait analysis. MATERIAL AND METHODS Lenke 1 or 2 AIS patients planned for surgery were included. The day before surgery, they underwent radiographic evaluation and gait analysis. Among the gait parameters, sagittal vertical axis (Dyn-SVA), shoulder line rotation (Dyn-SL rotation), pelvis rotation (Dyn-P rotation) and acromion pelvis angle (Dyn-APA) were measured. AIS patients were compared to 25 asymptomatic controls. RESULTS A total of 57 patients were included in the study, with a mean Cobb angle of 55.4°. AIS patients had a lower Dyn-SVA when compared to controls (47.0 vs. 62.9 mm, p = 0.012). Dyn-APA and Dyn-SL rotation were negative in AIS patients, meaning that shoulder line was rotated towards the left (- 6.4 vs. 7.8° and - 7.5 vs. - 0.4°, p<0.001, respectively). On the other hand, Dyn-P rotation was positive, meaning that pelvis was rotated towards the right side during gait (1.1 vs. - 0.5, p = 0.026). DISCUSSION This is one of the largest series of gait analysis in AIS patients. We demonstrated that AIS patients have an abnormal gait pattern, with a decreased anterior tilt of the trunk and transverse plane abnormalities. We found that gait deviation was not related to radiographic measurements, pointing out that dynamic assessment provides new data about spinal posture. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Sébastien Pesenti
- Paediatric Orthopaedics, Hopital d'enfants de la Timone, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France.
- Gait Analysis Platform, Timone, Aix Marseille University, Marseille, France.
- Orthopédie pédiatrique, APHM, CNRS, ISM, Hôpital de la Timone, Aix Marseille University, Marseille, France.
| | - Solenne Prost
- Paediatric Orthopaedics, Hopital d'enfants de la Timone, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
- Gait Analysis Platform, Timone, Aix Marseille University, Marseille, France
- Orthopédie pédiatrique, APHM, CNRS, ISM, Hôpital de la Timone, Aix Marseille University, Marseille, France
| | - Vincent Pomero
- Gait Analysis Platform, Timone, Aix Marseille University, Marseille, France
| | - Guillaume Authier
- Gait Analysis Platform, Timone, Aix Marseille University, Marseille, France
| | - Mathieu Severyns
- Paediatric Orthopaedics, Hopital d'enfants de la Timone, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
| | - Elke Viehweger
- Paediatric Orthopaedics, Hopital d'enfants de la Timone, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
- Gait Analysis Platform, Timone, Aix Marseille University, Marseille, France
- Orthopédie pédiatrique, APHM, CNRS, ISM, Hôpital de la Timone, Aix Marseille University, Marseille, France
| | - Benjamin Blondel
- Paediatric Orthopaedics, Hopital d'enfants de la Timone, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
- Gait Analysis Platform, Timone, Aix Marseille University, Marseille, France
- Orthopédie pédiatrique, APHM, CNRS, ISM, Hôpital de la Timone, Aix Marseille University, Marseille, France
| | - Jean-Luc Jouve
- Paediatric Orthopaedics, Hopital d'enfants de la Timone, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
- Gait Analysis Platform, Timone, Aix Marseille University, Marseille, France
- Orthopédie pédiatrique, APHM, CNRS, ISM, Hôpital de la Timone, Aix Marseille University, Marseille, France
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15
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Pesenti S, Prost S, Blondel B, Pomero V, Severyns M, Roscigni L, Authier G, Viehweger E, Jouve JL. Correlations linking static quantitative gait analysis parameters to radiographic parameters in adolescent idiopathic scoliosis. Orthop Traumatol Surg Res 2019; 105:541-545. [PMID: 30930135 DOI: 10.1016/j.otsr.2018.09.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/01/2018] [Accepted: 09/24/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Radiography is the main tool used to assess spinal deformities in patients with adolescent idiopathic scoliosis (AIS) but requires repeated exposure to ionising radiation, potentially raising safety concerns. Consequently, new methods are needed. Among them, the acquisition of static parameters during quantitative gait analysis (QGA) has received attention in recent years. However, no data on correlations linking static QGA parameters to standard radiographic parameters are available. The objective of this study was to assess correlations between static QGA parameters and standard radiographic parameters in patients with AIS. HYPOTHESIS Spinal deformities in patients with AIS can be evaluated based on static QGA parameters. PATIENTS AND METHODS We studied patients scheduled for surgery to treat AIS. On the day before surgery, QGA was performed and antero-posterior and lateral radiographs obtained. QGA involved analysing the positions of 32 reflective markers, including 6 used to assess the spine. The coronal vertical axis (CVA), thoracic and lumbar Cobb angles, sagittal vertical axis (SVA), thoracic kyphosis, lumbar lordosis, and pelvic tilt were recorded and compared to the corresponding radiographic parameters. RESULTS The study included 57 patients, including 48 (84%) females, with a mean age of 15.2 years. Among them, 45 had Lenke 1 and 12 Lenke 5 scoliosis. The mean main Cobb angle was 51.9°. In the coronal plane, significant correlations with the corresponding radiographic parameters were found for the CVA (R=0.524, p<0.01) and thoracic Cobb angle (R=0.599, p<0.01). All the sagittal parameters correlated significantly with the corresponding radiographic parameters: SVA, R=0.313; pelvic tilt, R=0.342; thoracic kyphosis, R=0.575; and lumbar lordosis, R=0.360 (p<0.05 for all four parameters). CONCLUSIONS In this study, static QGA parameters accurately reflected the spinal deformities visualised radiographically. The lumbar deformity was more difficult to characterise, probably because it was mild in our population. Research efforts should focus on improving the performance of QGA, notably for detecting curve progression. Thus, QGA may allow a decrease in radiation exposure of patients with AIS. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sébastien Pesenti
- Service d'orthopédie pédiatrique, Aix-Marseille université, Timone Enfants, Marseille, France; Plateforme d'analyse de la motricité, Aix-Marseille université, Timone, Marseille, France; Orthopédie pédiatrique, CNRS, ISM, Aix-Marseille université, hôpital de la Timone, AP-HM, Marseille, France.
| | - Solène Prost
- Service d'orthopédie pédiatrique, Aix-Marseille université, Timone Enfants, Marseille, France; Plateforme d'analyse de la motricité, Aix-Marseille université, Timone, Marseille, France
| | - Benjamin Blondel
- Service d'orthopédie pédiatrique, Aix-Marseille université, Timone Enfants, Marseille, France; Plateforme d'analyse de la motricité, Aix-Marseille université, Timone, Marseille, France; Orthopédie pédiatrique, CNRS, ISM, Aix-Marseille université, hôpital de la Timone, AP-HM, Marseille, France
| | - Vincent Pomero
- Plateforme d'analyse de la motricité, Aix-Marseille université, Timone, Marseille, France
| | - Mathieu Severyns
- Service d'orthopédie pédiatrique, Aix-Marseille université, Timone Enfants, Marseille, France
| | - Lionel Roscigni
- Service d'orthopédie pédiatrique, Aix-Marseille université, Timone Enfants, Marseille, France; Plateforme d'analyse de la motricité, Aix-Marseille université, Timone, Marseille, France
| | - Guillaume Authier
- Plateforme d'analyse de la motricité, Aix-Marseille université, Timone, Marseille, France
| | - Elke Viehweger
- Service d'orthopédie pédiatrique, Aix-Marseille université, Timone Enfants, Marseille, France; Plateforme d'analyse de la motricité, Aix-Marseille université, Timone, Marseille, France; Orthopédie pédiatrique, CNRS, ISM, Aix-Marseille université, hôpital de la Timone, AP-HM, Marseille, France
| | - Jean-Luc Jouve
- Service d'orthopédie pédiatrique, Aix-Marseille université, Timone Enfants, Marseille, France; Plateforme d'analyse de la motricité, Aix-Marseille université, Timone, Marseille, France; Orthopédie pédiatrique, CNRS, ISM, Aix-Marseille université, hôpital de la Timone, AP-HM, Marseille, France
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Šarčević Z, Tepavčević A. Association between adolescent idiopathic scoliosis and sacroiliac joint dysfunction in young athletes: A case control study. Medicine (Baltimore) 2019; 98:e15161. [PMID: 30985695 PMCID: PMC6485790 DOI: 10.1097/md.0000000000015161] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis, a 3-dimensional deviation in the axis of the spine. Etiology of AIS is unclear and the general belief is that AIS is multifactorial disorder possibly caused by different factors. It would be worthwhile to reveal new factors associated with AIS. The present study aimed to investigate association between sacroiliac joint (SIJ) dysfunction and AIS in young athletes.This case-control study included 196 children athletes (basketball, football, volleyball, handball, ballet, and others), 82 males and 114 females aged 8 to 17, 98 of them with the diagnosis of AIS. The case group consisted of young athletes examined at a regular checkup by a sport physician and diagnosed with AIS. The control group consisted of athletes matched to the case group according to sex, age, sports, number of training years and number of training hours per week, but without AIS.The scoliosis was diagnosed with Adams' forward bend test and the scoliometer measurement. The SIJ dysfunction was determined using the palpation meter (PALM) measuring the sagittal pelvic position in standing position and in standing position with the hip flexion angle of 90°. The data were analyzed using Student t test, Mann-Whitney U test, contingency coefficients, and logistic regression.The average difference in pelvic position in the sagittal plane (in standing position), with and without hip flexion 90° was found to be statistically different in the case and the control groups (t = 13.88, P = .00). There was a strong positive association between variables representing presence of AIS and SIJ dysfunction (determined by contingency coefficient C = 0.62, coefficient Phi = 0.79 and tetrachoric correlation coefficient 0.95).The logistic regression indicated that the average difference in pelvic position in the sagittal plane (in standing position), with and without hip flexion 90° was significantly associated with the probability of scoliosis in young athletes (P = .00, Wald test).There was a strong positive association between SIJ dysfunction and AIS in young athletes.
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Affiliation(s)
- Zoran Šarčević
- Novi Sad Health Care Centre, Sports Medicine Centre
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
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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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Patel A, Pivec R, Shah NV, Leven DM, Margalit A, Day LM, Godwin EM, Lafage V, Post NH, Yoshihara H, Diebo BG, Paulino CB. Motion analysis in the axial plane after realignment surgery for adolescent idiopathic scoliosis. Gait Posture 2018; 66:181-188. [PMID: 30195821 DOI: 10.1016/j.gaitpost.2018.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/05/2018] [Accepted: 08/18/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aimed to define changes occurring in axial plane motion after scoliosis surgery in patients with adolescent idiopathic scoliosis (AIS) using gait analysis. Pre- and postoperative axial plane motion was compared to healthy/control subjects. This may potentially improve our understanding of how motion is impacted by deformity and subsequent surgical realignment. METHODS 15 subjects with AIS underwent pre- and postoperative radiographic and gait analysis, with focus on axial plane motion (clockwise [CW] and counterclockwise [CCW]). Age, weight, and gender-matched controls (n = 13) were identified for gait analysis. Control, preoperative and postoperative groups were compared with paired student's t-tests. RESULTS Surgical realignment resulted in significantly decreased in upper thoracic, thoracic, thoracolumbar and lumbar Cobb angles pre-to-postoperatively (36.7° vs. 15.2°, 60.1° vs. 25.6°, 47.7° vs. 17.7° and 27.2° vs. 4.8°, respectively) (all p < 0.05), with no significant change in thoracic kyphosis, lumbar lordosis, central sacral vertical line, pelvic incidence, and sagittal vertical axis. However, pelvic tilt significantly increased from 4.9° to 8.1° (p = 0.035). Using gait analysis: preoperative thoracic axial rotation differed (mean CW and CCW rotation was 1.9° and 3.1° [p = 0.01]), whereas mean CW & CCW pelvic rotation remained symmetric (2.0° and 3.0°; p = 0.44). Postoperatively, CCW thoracic rotation range of motion decreased (CW: 0.6° and CCW: 1.4°; p = 0.31). No significant difference in postoperative pelvic rotation occurred (1.1° and 3.4°; p = 0.10). Compared to controls, AIS patients demonstrated no significant difference in total CW & CCW thoracic motion relative to the pelvis both pre- (14.9° and 12.3°, respectively; p = 0.45) and postoperatively (12.9° and 12.3°, respectively; p = 0.82). SIGNIFICANCE AIS patients demonstrated abnormal gait patterns in the axial plane compared to normal controls. After surgical realignment and de-rotation, marked improvement in axial plane motion was observed, highlighting how motion analysis can afford surgeons three-dimensional perspective into the patient's functional status.
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Affiliation(s)
- Ashish Patel
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, United States; Department of Spine Surgery, Methodist Hospitals, Merrillville, IN, United States
| | - Robert Pivec
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, United States
| | - Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, United States.
| | - Dante M Leven
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, United States; Department of Orthopaedic Surgery, Nassau University Medical Center, East Meadow, NY, United States
| | - Adam Margalit
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, United States
| | - Louis M Day
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, United States
| | - Ellen M Godwin
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, United States; Department of Physical Therapy, Long Island University, Brooklyn, NY, United States
| | - Virginie Lafage
- Spine Service, Hospital for Special Surgery, New York, NY, United States
| | - Nicholas H Post
- Division of Neurosurgery, Brookdale University Hospital Medical Center, Brooklyn, NY, United States
| | - Hiroyuki Yoshihara
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, United States
| | - Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, United States
| | - Carl B Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, United States
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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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Diebo BG, Shah NV, Pivec R, Naziri Q, Patel A, Post NH, Assi A, Godwin EM, Lafage V, Schwab FJ, Paulino CB. From Static Spinal Alignment to Dynamic Body Balance: Utilizing Motion Analysis in Spinal Deformity Surgery. JBJS Rev 2018; 6:e3. [DOI: 10.2106/jbjs.rvw.17.00189] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Noamani A, Vette AH, Preuss R, Popovic MR, Rouhani H. Optimal Estimation of Anthropometric Parameters for Quantifying Multisegment Trunk Kinetics. J Biomech Eng 2018; 140:2681897. [DOI: 10.1115/1.4040247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Indexed: 11/08/2022]
Abstract
Kinetics assessment of the human head-arms-trunk (HAT) complex via a multisegment model is a useful tool for objective clinical evaluation of several pathological conditions. Inaccuracies in body segment parameters (BSPs) are a major source of uncertainty in the estimation of the joint moments associated with the multisegment HAT. Given the large intersubject variability, there is currently no comprehensive database for the estimation of BSPs for the HAT. We propose a nonlinear, multistep, optimization-based, noninvasive method for estimating individual-specific BSPs and calculating joint moments in a multisegment HAT model. Eleven nondisabled individuals participated in a trunk-bending experiment and their body motion was recorded using cameras and a force plate. A seven-segment model of the HAT was reconstructed for each participant. An initial guess of the BSPs was obtained by individual-specific scaling of the BSPs calculated from the male visible human (MVH) images. The intersegmental moments were calculated using both bottom-up and top-down inverse dynamics approaches. Our proposed method adjusted the scaled BSPs and center of pressure (COP) offsets to estimate optimal individual-specific BSPs that minimize the difference between the moments obtained by top-down and bottom-up inverse dynamics approaches. Our results indicate that the proposed method reduced the error in the net joint moment estimation (defined as the difference between the net joint moment calculated via bottom-up and top-down approaches) by 79.3% (median among participants). Our proposed method enables an optimized estimation of individual-specific BSPs and, consequently, a less erroneous assessment of the three-dimensional (3D) kinetics of a multisegment HAT model.
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Affiliation(s)
- Alireza Noamani
- Department of Mechanical Engineering, University of Alberta, Edmonton T6G 1H9, AB, Canada e-mail:
| | - Albert H. Vette
- Department of Mechanical Engineering, University of Alberta, Edmonton T6G 1H9, AB, Canada
- Glenrose Rehabilitation Hospital, Alberta Health Services, 10230 111 Avenue NW, Edmonton T5G 0B7, AB, Canada e-mail:
| | - Richard Preuss
- School of Physical & Occupational Therapy, McGill University, Montreal H3G 1Y5, QC, Canada e-mail:
| | - Milos R. Popovic
- Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute–University Health Network, Toronto M4G 3V9, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto M5S 3G9, ON, Canada e-mail:
| | - Hossein Rouhani
- Department of Mechanical Engineering, University of Alberta, Edmonton T6G 1H9, AB, Canada e-mail:
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Asymmetrical trunk movement during walking improved to normal range at 3 months after corrective posterior spinal fusion in adolescent idiopathic scoliosis. 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 2017; 27:388-396. [PMID: 29218483 DOI: 10.1007/s00586-017-5369-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 10/29/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the effects of posterior spinal fusion (PSF) and curve type on upper body movements in Adolescent Idiopathic Scoliosis (AIS) patients during gait. METHODS Twenty-four girls (12-18 years) with AIS underwent PSF. 3D-Gait-analyses were performed preoperatively, at 3 months and 1 year postoperatively. Mean position (0° represents symmetry) and range of motion (ROM) of the trunk (thorax-relative-to-pelvis) in all planes were assessed. Lower body kinematics and spatiotemporal parameters were also evaluated. RESULTS Mean trunk position improved from 7.0° to 2.9° in transversal plane and from 5.0° to - 0.8° in frontal plane at 3 months postoperative (p < 0.001), and was maintained at 1 year. Trunk ROM in transverse plane decreased from 9.6° to 7.5° (p < 0.001) after surgery. No effects of PSF were observed on the lower body kinematics during the gait cycle. Patients with a double curve had a more axial rotated trunk before and after surgery (p = 0.013). CONCLUSION In AIS patients, during gait an evident asymmetrical position of the trunk improved to an almost symmetric situation already 3 months after PSF and was maintained at 1 year. Despite a reduction of trunk ROM, patients were able to maintain the same walking pattern in the lower extremities after surgery. This improvement of symmetry and maintenance of normal gait can explain the rapid recovery and well functioning in daily life of AIS patients, despite undergoing a fusion of large parts of their spine.
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