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Segi N, Nakashima H, Ito S, Ouchida J, Kayamoto A, Oishi R, Yamauchi I, Takegami Y, Ishizuka S, Seki T, Hasegawa Y, Imagama S. Is spinopelvic compensation associated with unstable gait?: Analysis using whole spine X-rays and a two-point accelerometer during gait in healthy adults. Gait Posture 2024; 111:22-29. [PMID: 38615565 DOI: 10.1016/j.gaitpost.2024.04.013] [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: 11/03/2023] [Revised: 02/29/2024] [Accepted: 04/10/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Pelvic incidence (PI)-lumbar lordosis (LL) mismatch has a significant destabilizing effect on the center of gravity sway in the static standing position. However, the association between spinopelvic alignment and balance during gait in healthy volunteers is poorly understood. RESEARCH QUESTION The degree of PI-LL mismatch and trunk anterior tilt in the static standing posture influences dynamic balance during gait. METHODS In this study, 131 healthy volunteers were divided into two groups: harmonious group (PI - LL ≤ 10°; n = 91) and unharmonious group (PI - LL > 10°; n = 40). A two-point accelerometer system was used for gait analysis; accelerometers were attached to the pelvis and upper trunk to measure acceleration in the forward-backward, right-left, and vertical directions so that sagittal (front-back) deviation width, coronal (right-left) width, and vertical width and their ratios were calculated. Measurements were compared between the two groups, and correlations between alignment and accelerometer data were examined. RESULTS The harmonious group showed a negative correlation between pelvic sagittal width and PI - LL, pelvic tilt (PT), and sagittal vertical axis (SVA) (correlation coefficient ρ = -0.42, -0.38, and -0.4, respectively), and a positive correlation between sagittal ratio and PI - LL (ρ = 0.35). The unharmonious group showed a positive correlation between pelvic sagittal width and PI and PT (ρ = 0.43 and 0.33, respectively) and between sagittal ratio and SVA (ρ = 0.32). The unharmonious group showed a positive correlation between upper trunk sagittal width and PI - LL and PT (ρ = 0.38 and 0.36, respectively). SIGNIFICANCE The association between spinal alignment and gait parameters differs depending on the presence or absence of PI-LL mismatch. The degree of pelvic compensation and trunk anterior tilt during static standing were associated with unstable gait balance.
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Affiliation(s)
- Naoki Segi
- Department of Orhopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan
| | - Hiroaki Nakashima
- Department of Orhopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan.
| | - Sadayuki Ito
- Department of Orhopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan
| | - Jun Ouchida
- Department of Orhopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan
| | - Azusa Kayamoto
- Department of Rehabilitation, Nagoya University Hospital,, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan
| | - Ryotaro Oishi
- Department of Orhopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan
| | - Ippei Yamauchi
- Department of Orhopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan
| | - Yasuhiko Takegami
- Department of Orhopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan
| | - Shinya Ishizuka
- Department of Orhopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan
| | - Taisuke Seki
- Department of Orthopedic Surgery, Aichi Medical University Medical Center, 17-33 Kawagoshi, Nikki, Okazaki, Aichi 444-2148, Japan
| | - Yukiharu Hasegawa
- Department of Rehabilitation, Kansai University of Welfare Sciences, 3-11-1, Asahigaoka, Kashiwara, Osaka 582-0026, Japan
| | - Shiro Imagama
- Department of Orhopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan
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Mohanty S, Mikhail C, Lai C, Hassan FM, Stephan S, Lewerenz E, Sardar ZM, Lehman RA, Lenke LG. Do adult spinal deformity patients who achieve and maintain PI-LL < 10 have better patient-reported and clinical outcomes compared to patients with PI-LL ≥ 10? A propensity score-matched analysis. Spine Deform 2024; 12:209-219. [PMID: 37819577 DOI: 10.1007/s43390-023-00766-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 09/03/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE To investigate whether patients with spinopelvic mismatch (PI-LL ≥ 10) report worse patient-reported outcomes (PROs) compared to patients who achieve PI-LL < 10 at 2-year postop. METHODS In this retrospective study, propensity score matching (PSM) was used to analyze patients who underwent posterior spinal fusion due to deformity, as defined by one or more of the following criteria: PI-LL ≥ 25°, T1 pelvic angle ≥ 30°, sagittal vertical axis ≥ 15 cm, thoracic scoliosis ≥ 70°, thoracolumbar scoliosis ≥ 50°, coronal malalignment ≥ 7 cm, or those who underwent a three-column osteotomy or fusion with ≥ 12 levels. Key outcomes were total Scoliosis Research Society-22r, Oswestry Disability Index (PROs), and reoperation at 1- and 2-year postop. Patients were dichotomized based on their 2-year alignment: PI-LL ≥ 10° and PI-LL < 10°. A multivariable logistic regression model identified factors associated with achieving PI-LL < 10°, and independent predictors were matched using propensity score matching. Binary outcomes within matched cohorts were analyzed using the McNemar test, while continuous outcomes were analyzed using the Wilcoxon rank-sum test. RESULTS One hundred sixty-four patients with 2-year follow-up were included; mean age was 50.5 (standard error mean (SEM): 1.4) years, body mass index was 24.1(SEM 1.0), and number of operative levels was 13.5 (SEM 0.3). 84 (51.2%) and 80 (48.8%) patients achieved PI-LL < 10 and PI-LL ≥ 10 at 2-year follow-up, respectively. Baseline pelvic incidence [odds ratio (OR): 0.96 (95% CI 0.92-0.99)] and baseline PI-LL [OR: 0.95 (95% CI 0.9-0.99)] were independent predictors of achieving PI-LL < 10 at 2 years. When comparing propensity matched pairs, no significant differences were found in baseline PROs. At both 1- and 2-year follow-up, outcomes on the SRS-22r scale were nearly identical for both groups (function [4.1(0.1) vs 4.0 (0.1), P = 0.75] ,Pain [3.9 (0.2) vs 3.9 (0.2), P = 0.86], appearance [4.2 (0.2) vs 3.8 (0.2), P = 0.08], mental health [4.1 (0.2) vs 4.1 (0.1), P = 0.96], satisfaction [4.4 (0.2) vs 4.4 (0.2), P = 0.72], and total [90.2 (2.5) vs 88.1 (2.5), P = 0.57]). Additionally, ODI scores at 2 years were comparable [18.1 (2.9) vs 22.4 (2.9), P = 0.30]. The 90-day reoperation rate was 2.6% (one patient) in both matched cohorts (P > 0.99). There was no significant difference in 1-year (P > 0.9999) or 2-year (P = 0.2207) reoperation rates between the groups. CONCLUSION Patients who achieve and maintain PI-LL < 10 2-years postop following adult spinal deformity surgery have nearly identical SRS-22r and ODI outcomes, and comparable 2-year reoperation rates as compared to patients who have PI-LL ≥ 10.
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Affiliation(s)
- Sarthak Mohanty
- Department of Orthopaedic Surgery, The Daniel and Jane Och Spine Hospital, New York Presbyterian /Columbia University Irving Medical Center, 5141 Broadway, New York, NY, 10034, USA
| | - Christopher Mikhail
- Department of Orthopaedic Surgery, The Daniel and Jane Och Spine Hospital, New York Presbyterian /Columbia University Irving Medical Center, 5141 Broadway, New York, NY, 10034, USA
| | - Christopher Lai
- Department of Orthopaedic Surgery, The Daniel and Jane Och Spine Hospital, New York Presbyterian /Columbia University Irving Medical Center, 5141 Broadway, New York, NY, 10034, USA
| | - Fthimnir M Hassan
- Department of Orthopaedic Surgery, The Daniel and Jane Och Spine Hospital, New York Presbyterian /Columbia University Irving Medical Center, 5141 Broadway, New York, NY, 10034, USA.
| | - Stephen Stephan
- Department of Orthopaedic Surgery, The Daniel and Jane Och Spine Hospital, New York Presbyterian /Columbia University Irving Medical Center, 5141 Broadway, New York, NY, 10034, USA
| | - Erik Lewerenz
- Department of Orthopaedic Surgery, The Daniel and Jane Och Spine Hospital, New York Presbyterian /Columbia University Irving Medical Center, 5141 Broadway, New York, NY, 10034, USA
| | - Zeeshan M Sardar
- Department of Orthopaedic Surgery, The Daniel and Jane Och Spine Hospital, New York Presbyterian /Columbia University Irving Medical Center, 5141 Broadway, New York, NY, 10034, USA
| | - Ronald A Lehman
- Department of Orthopaedic Surgery, The Daniel and Jane Och Spine Hospital, New York Presbyterian /Columbia University Irving Medical Center, 5141 Broadway, New York, NY, 10034, USA
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, The Daniel and Jane Och Spine Hospital, New York Presbyterian /Columbia University Irving Medical Center, 5141 Broadway, New York, NY, 10034, USA
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Lukas KJ, Verhaegen JCF, Livock H, Kowalski E, Phan P, Grammatopoulos G. The effect of ethnicity on the age-related changes of spinopelvic characteristics: a systematic review. Bone Joint Res 2023; 12:231-244. [PMID: 37051815 PMCID: PMC10065848 DOI: 10.1302/2046-3758.124.bjr-2022-0335.r1] [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] [Indexed: 04/03/2023] Open
Abstract
Aims Spinopelvic characteristics influence the hip’s biomechanical behaviour. However, to date there is little knowledge defining what ‘normal’ spinopelvic characteristics are. This study aims to determine how static spinopelvic characteristics change with age and ethnicity among asymptomatic, healthy individuals. Methods This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify English studies, including ≥ 18-year-old participants, without evidence of hip or spine pathology or a history of previous surgery or interventional treatment, documenting lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). From a total of 2,543 articles retrieved after the initial database search, 61 articles were eventually selected for data extraction. Results When all ethnicities were combined the mean values for LL, SS, PT, and PI were: 47.4° (SD 11.0°), 35.8° (SD 7.8°), 14.0° (SD 7.2°), and 48.8° (SD 10°), respectively. LL, SS, and PT had statistically significant (p < 0.001) changes per decade at: −1.5° (SD 0.3°), −1.3° (SD 0.3°), and 1.4° (SD 0.1°). Asian populations had the largest age-dependent change in LL, SS, and PT compared to any other ethnicity per decade at: −1.3° (SD 0.3°) to −0.5° (SD 1.3°), –1.2° (SD 0.2°) to −0.3° (SD 0.3°), and 1.7° (SD 0.2°) versus 1.1° (SD 0.1°), respectively. Conclusion Ageing alters the orientation between the spine and pelvis, causing LL, SS, and PT to modify their orientations in a compensatory mechanism to maintain sagittal alignment for balance when standing. Asian populations have the largest degree of age-dependent change to their spinopelvic parameters compared to any other ethnicity, likely due to their lower PI. Cite this article: Bone Joint Res 2023;12(4):231–244.
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Affiliation(s)
- Kenneth J. Lukas
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Jeroen C. F. Verhaegen
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
- University Hospital Antwerp, Edegem, Belgium
- Orthopedic Center Antwerp, Antwerp, Belgium
| | - Holly Livock
- Division of Orthopaedic Surgery, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | | | - Philippe Phan
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
- Correspondence should be sent to George Grammatopoulos. E-mail:
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Wang W, Pan F, Wang P, Wang W, Wang Y, Kong C, Lu S. Biomechanical Response of Four Roussouly's Sagittal Alignment Lumbar to Degeneration of Different Parts of Intervertebral Disc: Finite Element Model Analysis. Ing Rech Biomed 2023. [DOI: 10.1016/j.irbm.2023.100772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Rizkallah M, Assi A, El Abiad R, Adib S, Ghanem I. Comments on: "From statistical significance to clinical relevance: The contribution of new assessment instruments" of S Klouche, S Putman, E Cavaignac, X Bayle-Iniguez, J Murgier published in Orthop Traumatol Surg Res. 2021 May;107(3):102879. doi: 10.1016/j.otsr.2021.102879. From statistical significance to clinical relevance: What about the objective outcomes? Orthop Traumatol Surg Res 2022; 108:103334. [PMID: 35605935 DOI: 10.1016/j.otsr.2022.103334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 05/17/2022] [Indexed: 02/03/2023]
Affiliation(s)
| | - Ayman Assi
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Rami El Abiad
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon; Department of Orthopedic Surgery, Hôtel-Dieu de France University Hospital, Saint-Joseph University, Beirut, Lebanon
| | - Salim Adib
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ismat Ghanem
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon; Department of Orthopedic Surgery, Hôtel-Dieu de France University Hospital, Saint-Joseph University, Beirut, Lebanon
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Chung NS, Lee HD, Jeon CH. Degenerative changes of sagittal alignment in patients with Roussouly type 1. Spine Deform 2020; 8:1325-1331. [PMID: 32488766 DOI: 10.1007/s43390-020-00151-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN A cross-sectional radiological study. OBJECTIVES We aimed to examine the degenerative changes of sagittal alignment in patients with Roussouly type 1. Roussouly type 1 is unique in shape, characterized by short lumbar lordosis (LL) with the apex at L5 and thoracolumbar kyphosis (TLK). Because of the unique shape of sagittal alignment and the small pelvic incidence (PI) in Roussouly type 1, the degenerative changes of sagittal alignment may differ. METHODS A total of 145 patients with Roussouly type 1 were recruited and distributed into three age groups; Group I (N = 40) were young patients (20-40 years of age), Group II (N = 47) were middle-aged patients (45-60 years of age), and Group III (N = 48) were elderly patients (>65 years of age). Sagittal parameters including sagittal vertical axis (SVA), PI, pelvic tilt (PT), L1S1 LL, L4S1 LL, thoracic kyphosis (TK), and TLK were measured using Surgimap® software. The occurrence of lumbar retrolisthesis was also examined. RESULTS The SVA, PI, PT, L1S1 LL, L4S1 LL, TK, and TLK in group I were - 25.9° ± 23.4 mm, 37.1° ± 5.3°, 10.3° ± 5.5°, 42.7° ± 8.8°, 35.5° ± 6.9°, 29.5° ± 23.5°, and 9.7° ± 5.9°, respectively. Among the Groups I, II, and III, there was a stepwise increase in the SVA, PT, TLK, and lumbar retrolisthesis (all P < 0.001). The PI, L4S1 LL, and TK were identical among the three groups. CONCLUSIONS Degenerative changes of Roussouly type 1 include increase in the SVA, PT, TLK, and lumbar retrolisthesis, while the PI, L4S1 LL, and TK remain unchanged. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Nam-Su Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, Geyounggi-do, 16499, South Korea
| | - Han-Dong Lee
- Department of Orthopaedic Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, Geyounggi-do, 16499, South Korea
| | - Chang- Hoon Jeon
- Department of Orthopaedic Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, Geyounggi-do, 16499, South Korea.
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van Erp JHJ, Gielis WP, Arbabi V, de Gast A, Weinans H, Arbabi S, Öner FC, Castelein RM, Schlösser TPC. Unravelling the knee-hip-spine trilemma from the CHECK study. Bone Joint J 2020; 102-B:1261-1267. [PMID: 32862680 DOI: 10.1302/0301-620x.102b9.bjj-2019-1315.r2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aetiologies of common degenerative spine, hip, and knee pathologies are still not completely understood. Mechanical theories have suggested that those diseases are related to sagittal pelvic morphology and spinopelvic-femoral dynamics. The link between the most widely used parameter for sagittal pelvic morphology, pelvic incidence (PI), and the onset of degenerative lumbar, hip, and knee pathologies has not been studied in a large-scale setting. METHODS A total of 421 patients from the Cohort Hip and Cohort Knee (CHECK) database, a population-based observational cohort, with hip and knee complaints < 6 months, aged between 45 and 65 years old, and with lateral lumbar, hip, and knee radiographs available, were included. Sagittal spinopelvic parameters and pathologies (spondylolisthesis and degenerative disc disease (DDD)) were measured at eight-year follow-up and characteristics of hip and knee osteoarthritis (OA) at baseline and eight-year follow-up. Epidemiology of the degenerative disorders and clinical outcome scores (hip and knee pain and Western Ontario and McMaster Universities Osteoarthritis Index) were compared between low PI (< 50°), normal PI (50° to 60°), and high PI (> 60°) using generalized estimating equations. RESULTS Demographic details were not different between the different PI groups. L4 to L5 and L5 to S1 spondylolisthesis were more frequently present in subjects with high PI compared to low PI (L4 to L5, OR 3.717; p = 0.024 vs L5 to S1 OR 7.751; p = 0.001). L5 to S1 DDD occurred more in patients with low PI compared to high PI (OR 1.889; p = 0.010), whereas there were no differences in L4 to L5 DDD among individuals with a different PI. The incidence of hip OA was higher in participants with low PI compared to normal (OR 1.262; p = 0.414) or high PI (OR 1.337; p = 0.274), but not statistically different. The incidence of knee OA was higher in individuals with a high PI compared to low PI (OR 1.620; p = 0.034). CONCLUSION High PI is a risk factor for development of spondylolisthesis and knee OA. Low pelvic incidence is related to DDD, and may be linked to OA of the hip. Level of Evidence: 1b Cite this article: Bone Joint J 2020;102-B(9):1261-1267.
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Affiliation(s)
- Joost H J van Erp
- Clinical Orthopedic Research Center Midden-Nederland, Zeist, Netherlands.,Department of Orthopedics, Diakonessenhuis Utrecht, Netherlands.,Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Willem P Gielis
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Vahid Arbabi
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands.,Orthopaedic-BiMechanics Research Group, Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Birjand, Iran
| | - Arthur de Gast
- Clinical Orthopedic Research Center Midden-Nederland, Zeist, Netherlands.,Department of Orthopedics, Diakonessenhuis Utrecht, Netherlands
| | - Harrie Weinans
- Clinical Orthopedic Research Center Midden-Nederland, Zeist, Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Saeed Arbabi
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands.,Image Sciences Institute, University Medical Center Utrecht, Utrecht, Netherlands
| | - F Cumhur Öner
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - René M Castelein
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Tom P C Schlösser
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
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Influence of spino-pelvic and postural alignment parameters on gait kinematics. Gait Posture 2020; 76:318-326. [PMID: 31891899 DOI: 10.1016/j.gaitpost.2019.12.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/07/2019] [Accepted: 12/21/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Postural alignment is altered with spine deformities that might occur with age. Alteration of spino-pelvic and postural alignment parameters are known to affect daily life activities such as gait. It is still unknown how spino-pelvic and postural alignment parameters are related to gait kinematics. RESEARCH QUESTION To assess the relationships between spino-pelvic/postural alignment parameters and gait kinematics in asymptomatic adults. METHODS 134 asymptomatic subjects (aged 18-59 years) underwent 3D gait analysis, from which kinematics of the pelvis and lower limbs were extracted in the 3 planes. Subjects then underwent full-body biplanar X-rays, from which skeletal 3D reconstructions and spino-pelvic and postural alignment parameters were obtained such as sagittal vertical axis (SVA), center of auditory meatus to hip axis plumbline (CAM-HA), thoracic kyphosis (TK) and radiologic pelvic tilt (rPT). In order to assess the influence of spino-pelvic and postural alignment parameters on gait kinematics a univariate followed by a multivariate analysis were performed. RESULTS SVA was related to knee flexion during loading response (β = 0.268); CAM-HA to ROM pelvic obliquity (β = -0.19); rPT to mean pelvic tilt (β = -0.185) and ROM pelvic obliquity (β = -0.297); TK to ROM hip flexion/extension in stance (β = -0.17), mean foot progression in stance (β = -0.329), walking speed (β = -0.19), foot off (β = 0.223) and step length (β = -0.181). SIGNIFICANCE This study showed that increasing SVA, CAM-HA, TK and rPT, which is known to occur in adults with spinal deformities, could alter gait kinematics. Increases in these parameters, even in asymptomatic subjects, were related to a retroverted pelvis during gait, a reduced pelvic obliquity and hip flexion/extension mobility, an increased knee flexion during loading response as well as an increase in external foot progression angle. This was associated with a decrease in the walking pace: reduced speed, step length and longer stance phase.
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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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