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Ouchida J, Nakashima H, Ito S, Segi N, Yamauchi I, Oishi R, Miyairi Y, Morita Y, Ode Y, Nagatani Y, Okada Y, Tsushima M, Kanemura T, Machino M, Ohara T, Ota K, Tachi H, Tsuji T, Kagami Y, Shinjo R, Imagama S. Longitudinal impact of multi-segment spinal fixation surgery on mobility status and clinical outcomes in adult spinal deformity: a multicenter retrospective 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 2024; 33:3894-3903. [PMID: 38976001 DOI: 10.1007/s00586-024-08397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE To investigate changes in postoperative mobility status in patients with ASD, and the determining factors that influence these changes and their impact on clinical outcomes, including the rate of home discharge and long-term mobility. METHODS A total of 299 patients with ASD who underwent multi-segment posterior spinal fusion were registered in a multi-center database were investigated. Patient mobility status was assessed using walking aids and classified into five levels (1: independent, 2: cane, 3: walker, 4: assisted, and 5: wheelchair) preoperatively, at discharge, and after 2 years. We determined improvements or declines in the patient's mobility based on changes in the classification levels. The analysis focused on the factors contributing to the deterioration of postoperative mobility. RESULTS Two years postoperatively, 87% of patients maintained or improved mobility. However, 27% showed decreased mobility status at discharge, associated with a lower rate of home discharge (49% vs. 80% in the maintained mobility group) and limited improvement in mobility status (35% vs. 5%) after 2 years. Notably, postoperative increases in thoracic kyphosis (7.0 ± 12.1 vs. 2.0 ± 12.4°, p = 0.002) and lower lumbar lordosis (4.2 ± 13.1 vs. 1.8 ± 12.6°, p = 0.050) were substantial factors in mobility decline. CONCLUSION Postoperative mobility often temporarily decreases but generally improves after 2 years. However, an overcorrection in sagittal alignment, evidenced by increased TK, could detrimentally affect patients' mobility status. Transient mobility decline associated with overcorrection may require further rehabilitation or hospitalization. Further studies are required to determine the biomechanical effects of surgical correction on mobility.
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Affiliation(s)
- Jun Ouchida
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Sadayuki Ito
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Naoki Segi
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Ippei Yamauchi
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Ryotaro Oishi
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yuichi Miyairi
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yoshinori Morita
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yukihito Ode
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yasuhiro Nagatani
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yuya Okada
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Mikito Tsushima
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Masaaki Machino
- Department of Orthopedics and Spine Surgery, Meijo Hospital, Nagoya, Japan
| | - Tetsuya Ohara
- Department of Orthopedics and Spine Surgery, Meijo Hospital, Nagoya, Japan
| | - Kyotaro Ota
- Department of Orthopedic Surgery, Toyota Kosei Hospital, Toyota, Japan
| | - Hiroto Tachi
- Department of Orthopedic Surgery, Toyota Kosei Hospital, Toyota, Japan
| | - Taichi Tsuji
- Department of Orthopedic Surgery, Toyota Kosei Hospital, Toyota, Japan
| | - Yujiro Kagami
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Ryuichi Shinjo
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan
| | - Shiro Imagama
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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Ouchida J, Nakashima H, Ito S, Segi N, Yamauchi I, Oishi R, Miyairi Y, Morita Y, Ode Y, Nagatani Y, Okada Y, Tsushima M, Machino M, Ota K, Tachi H, Kagami Y, Shinjo R, Ohara T, Tsuji T, Kanemura T, Imagama S. Does global spinal alignment affect the use of walking aids after multi-segment spinal fixation for patients with ASD? A multicenter retrospective 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 2024; 33:3833-3841. [PMID: 38922414 DOI: 10.1007/s00586-024-08380-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE This study aimed to clarify the relation between global spinal alignment and the necessity of walking aid use in patients with adult spinal deformity (ASD) and to investigate the impact of spinal fixation on mobility status after surgery. METHODS In total, 456 older patients with ASD who had multi-segment spinal fixation surgery and were registered in a multi-center database were investigated. Patients under 60 years of age and those unable to walk preoperatively were excluded. Patients were classified by their mobility status into the independent, cane, and walker groups. Comparison analysis was conducted using radiographic spinopelvic parameters and the previously reported global spine balance (GSB) classification. In addition, preoperative and 2 years postoperative mobility statuses were investigated. RESULTS Of 261 patients analyzed, 66 used walking aids (canes, 46; walkers, 20). Analysis of preoperative radiographical parameters showed increased pelvic incidence and pelvic incidence-lumbar lordosis mismatch in the walker group and increased sagittal vertebral axis in the cane and walker groups versus the independent group. Analysis of GSB classification showed a higher percentage of walker use in those with severe imbalance (grade 3) in the sagittal classification but not in the coronal classification. While postoperative radiographical improvements were noted, there was no significant difference in the use of walking aids before and 2 years after surgery (P = 0.085). CONCLUSION A significant correlation was found between "sagittal" spinal imbalance and increased reliance on walking aids, particularly walkers. However, the limitation of improvement in postoperative mobility status suggested that multiple factors influence the mobility ability of elderly patients with ASD.
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Affiliation(s)
- Jun Ouchida
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan.
| | - Sadayuki Ito
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
| | - Naoki Segi
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
| | - Ippei Yamauchi
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
| | - Ryotaro Oishi
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
| | - Yuichi Miyairi
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
| | - Yoshinori Morita
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
| | - Yukihito Ode
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
| | - Yasuhiro Nagatani
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
| | - Yuya Okada
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
| | - Mikito Tsushima
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Masaaki Machino
- Department of Orthopedics and Spine Surgery, Meijo Hospital, Nagoya, Japan
| | - Kyotaro Ota
- Department of Orthopedic Surgery, Toyota Kosei Hospital, Toyota, Japan
| | - Hiroto Tachi
- Department of Orthopedic Surgery, Toyota Kosei Hospital, Toyota, Japan
| | - Yujiro Kagami
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan
| | - Ryuichi Shinjo
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan
| | - Tetsuya Ohara
- Department of Orthopedics and Spine Surgery, Meijo Hospital, Nagoya, Japan
| | - Taichi Tsuji
- Department of Orthopedic Surgery, Toyota Kosei Hospital, Toyota, Japan
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Shiro Imagama
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
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Goto G, Ariga K, Tanaka N, Oda K, Haro H, Ohba T. Clinical Significance of Pose Estimation Methods Compared with Radiographic Parameters in Adolescent Patients with Idiopathic Scoliosis. Spine Surg Relat Res 2024; 8:485-493. [PMID: 39399450 PMCID: PMC11464822 DOI: 10.22603/ssrr.2023-0269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/06/2024] [Indexed: 10/15/2024] Open
Abstract
Introduction Human pose estimation, a computer vision technique that identifies body parts and constructs human body representations from images and videos, has recently demonstrated high performance through deep learning. However, its potential application in clinical photography remains underexplored. This study aimed to establish photographic parameters for patients with adolescent idiopathic scoliosis (AIS) using pose estimation and to determine correlations between these photographic parameters and corresponding radiographic measures. Methods We conducted a study involving 42 patients with AIS who had undergone spinal correction surgery and conservative treatment. Preoperative photographs were captured using an iPhone 13 Pro mounted on a tripod positioned at the head of an X-ray tube. From the outputs of pose estimation, we derived five photographic parameters and subsequently conducted a statistical analysis to assess their correlations with relevant conventional radiographic parameters. Results In the sagittal plane, we identified significant correlations between photographic and radiographic parameters measuring trunk tilt angles. In the coronal plane, significant correlations were found between photographic parameters measuring shoulder height and trunk tilt and corresponding radiographic measurements. Conclusions The results suggest that pose estimation, achievable with common mobile devices, offers potential for AIS screening, early detection, and continuous posture monitoring, effectively mitigating the need for X-ray radiation exposure. Level of Evidence: 3.
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Affiliation(s)
- Go Goto
- Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan
- National Hospital Organization Kofu National Hospital, Yamanashi, Japan
| | | | - Nobuki Tanaka
- Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan
| | - Kotaro Oda
- Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan
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Pesenti S, Prost S, Solla F, Ilharreborde B, Ferrero E, Obeid I, Riouallon G, Laouissat F, Charles YP, Blondel B. Modern Concepts in Sagittal Curve Measurement: Comparison of Spline-Based and Fixed Landmark Measurements in a Cohort of 1520 Healthy Subjects. Spine (Phila Pa 1976) 2024; 49:1012-1020. [PMID: 38093610 DOI: 10.1097/brs.0000000000004901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/24/2023] [Indexed: 06/25/2024]
Abstract
STUDY DESIGN Retrospective multicenter study. OBJECTIVE Our objective was to compare the spline-based measurement of sagittal spinal curvatures to fixed landmarks in a normative population. SUMMARY OF BACKGROUND DATA Recent research has stressed the importance of considering sagittal curvature in its entirety using a spline reconstruction. To date, no data supports the superiority of this method in comparison to classic measurement methods. PATIENTS AND METHODS Full-spine biplanar radiographs of subjects over 20 years old who had normal radiographs were analyzed. Thoracic kyphosis (TK) and lumbar lordosis (LL) were measured following two modalities: either using predefined landmarks (TK T1T12 , TK T5T12 , and LL L1S1 ) or spline-based measurement (TK Spline and LL spline ). RESULTS A total of 1520 subjects were included (mean 54yo). The mean difference between TK spline and TK T1T12 was 1.4° and between TK spline and TK T5T12 was 11.7° ( P <0.001). LL spline was significantly larger than LL L1S1 (55° vs . 54°, P<0.001 ). LL spline and LL L1S1 were correlated ( R =0.950, P <0.001). Pelvic incidence had no influence on the difference between LL spline and LL L1S1 ( R =-0.034, P= 0.184). Using LL L1S1 measurements, LL was underestimated in 17% of the cases. The comparison of outlier distributions according to age groups ( P =0.175), sex ( P =0.937), or pelvic incidence groups ( P =0.662) found no difference. There were significantly more outliers in Roussouly type 1 compared with other types (56%, P <0.001). CONCLUSION Our results suggest that the use of TK T1T12 and LL L1S1 is acceptable to assess spinal sagittal curvatures. However, TK T5T12 is not accurate for the thoracic curve and should be used with caution. LL L1S1 can be used to accurately assess the lumbar curve, except in Roussouly type 1.
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Affiliation(s)
- Sébastien Pesenti
- Orthopédie Pédiatrique, CHU Timone Enfants, AP-HM, Aix-Marseille Université, Marseille, France
| | - Solene Prost
- Aix-Marseille Université, APHM, CNRS, ISM, CHU Timone, Unité de chirurgie rachidienne, Marseille, France
| | | | - Brice Ilharreborde
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Île-de-France, France
| | - Emmanuelle Ferrero
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France
| | | | - Guillaume Riouallon
- Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | - Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Benjamin Blondel
- Aix-Marseille Université, APHM, CNRS, ISM, CHU Timone, Unité de chirurgie rachidienne, Marseille, France
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Arima H, Hasegawa T, Yamato Y, Kato M, Yoshida G, Banno T, Oe S, Ide K, Yamada T, Nakai K, Kurosu K, Matsuyama Y. Cost-Effectiveness of Corrective Fusion Surgeries for Adult Spinal Deformities: Does Unexpected Revision Surgery Affect Cost-Effectiveness? Spine Surg Relat Res 2024; 8:306-314. [PMID: 38868785 PMCID: PMC11165507 DOI: 10.22603/ssrr.2023-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/10/2023] [Indexed: 06/14/2024] Open
Abstract
Introduction Previous research has demonstrated that mid- to long-term health-related quality of life following corrective fusion surgery for adult spinal deformity (ASD) can be improved by appropriate revision surgery. In this study, we aim to compare the cost-effectiveness of corrective fusion surgery for ASD with and without unexpected revision surgery 5 years postoperatively. Methods In total, 79 patients with ASD (mean age, 68.7 years) who underwent corrective fusion surgery between 2013 and 2015 were included in this study. Cost-effectiveness was evaluated based on the cost of obtaining 1 quality-adjusted life year (QALY). Patients were divided into two groups according to the presence or absence of unexpected revision surgery following corrective fusion and were subjected for comparison. Results As per our study findings, 26 (33%) of the 79 ASD patients underwent unexpected revision surgery during the first 5 years following surgery. Although there was no significant difference in terms of inpatient medical costs at the time of initial surgery for 5 years after surgery between the two groups (no-revision group, revision group; inpatient medical costs at the time of initial surgery: USD 69,854 vs. USD 72,685, P=0.344), the total medical expenses up to 5 years after surgery were found to be higher in the revision group (USD 72,704 vs. USD 104,287, P<0.001). The medical expenses required to improve 1 QALY 5 years after surgery were USD 178,476 in the no-revision group, whereas it was USD 222,081 in the revision group. Conclusions Although the total medical expenses were higher in the revision group, no significant difference was observed in the cumulative QALY improvement between the revision and no-revision groups. Moreover, the medical expenses required to improve 1 QALY were higher in the revision group, with a difference of approximately 20%.
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Affiliation(s)
- Hideyuki Arima
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Next Generation Creative Education Center for Medicine, Engineering, and Informatics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiko Hasegawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masashi Kato
- Division of Medical Profession, Hamamatsu University Hospital, Hamamatsu, Japan
| | - Go Yoshida
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Banno
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shin Oe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Koichiro Ide
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Yamada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Keiichi Nakai
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kenta Kurosu
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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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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Sakaguchi T, Meena U, Tanaka M, Xiang H, Fujiwara Y, Arataki S, Taoka T, Takamatsu K, Yasuda Y, Nakagawa M, Utsunomiya K. Minimal Clinically Important Differences in Gait and Balance Ability in Patients Who Underwent Corrective Long Spinal Fusion for Adult Spinal Deformity. J Clin Med 2023; 12:6500. [PMID: 37892638 PMCID: PMC10607759 DOI: 10.3390/jcm12206500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
STUDY DESIGN Retrospective observational study. BACKGROUND The risk of a femoral neck fracture due to a fall after adult spinal deformity surgery has been reported. One of the most significant factors among walking and balance tests in post-operative ASD patients was the timed up-and-go test (TUG). This study aims to calculate the minimal clinically important difference (MCID) in balance tests after ASD surgery. METHODS Forty-eight patients, 4 males and 44 females, were included by exclusion criteria in 66 consecutive patients who underwent corrective surgery as a treatment for ASD at our institution from June 2017 to February 2022. The inclusion criteria for this study were age ≥50 years; and no history of high-energy trauma. The exclusion criteria were dementia, severe deformity of the lower extremities, severe knee or hip osteoarthritis, history of central nervous system disorders, cancer, and motor severe paralysis leading to gait disorders. The surgeries were performed in two stages, first, the oblique lumber interbody fusion (OLIF) L1 to L5 (or S1), and second, the posterior corrective fusion basically from T10 to pelvis. For outcome assessment, 10 m walk velocity, TUG, ODI, and spinopelvic parameters were used. RESULTS Ten meter walk velocity of pre-operation and post-operation were 1.0 ± 0.3 m/s and 1.2 ± 0.2 m/s, respectively (p < 0.01). The TUG of pre-operation and post-operation were 12.1 ± 3.7 s and 9.7 ± 2.2 s, respectively (p < 0.01). The ODI improved from 38.6 ± 12.8% to 24.2 ± 15.9% after surgery (p < 0.01). All post-operative parameters except PI obtained statistically significant improvement after surgery. CONCLUSIONS This is the first report of MCID of the 10 m walk velocity and TUG after ASD surgery. Ten meter walk velocity and the TUG improved after surgery; their improvement values were correlated with the ODI. MCID using the anchor-based approach for 10 m walk velocity and the TUG were 0.10 m/s and 2.0 s, respectively. These MCID values may be useful for rehabilitation after ASD surgery.
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Affiliation(s)
- Tomoyoshi Sakaguchi
- Department of Rehabilitation, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (T.S.); (K.T.); (Y.Y.); (M.N.); (K.U.)
| | - Umesh Meena
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (U.M.); (H.X.); (Y.F.); (S.A.); (T.T.)
| | - Masato Tanaka
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (U.M.); (H.X.); (Y.F.); (S.A.); (T.T.)
| | - Hongfei Xiang
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (U.M.); (H.X.); (Y.F.); (S.A.); (T.T.)
| | - Yoshihiro Fujiwara
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (U.M.); (H.X.); (Y.F.); (S.A.); (T.T.)
| | - Shinya Arataki
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (U.M.); (H.X.); (Y.F.); (S.A.); (T.T.)
| | - Takuya Taoka
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (U.M.); (H.X.); (Y.F.); (S.A.); (T.T.)
| | - Kazuhiko Takamatsu
- Department of Rehabilitation, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (T.S.); (K.T.); (Y.Y.); (M.N.); (K.U.)
| | - Yosuke Yasuda
- Department of Rehabilitation, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (T.S.); (K.T.); (Y.Y.); (M.N.); (K.U.)
| | - Masami Nakagawa
- Department of Rehabilitation, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (T.S.); (K.T.); (Y.Y.); (M.N.); (K.U.)
| | - Kayo Utsunomiya
- Department of Rehabilitation, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (T.S.); (K.T.); (Y.Y.); (M.N.); (K.U.)
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Saad N, Moustafa IM, Ahbouch A, Alsaafin NM, Oakley PA, Harrison DE. Are Rotations and Translations of Head Posture Related to Gait and Jump Parameters? J Clin Med 2023; 12:6211. [PMID: 37834858 PMCID: PMC10573992 DOI: 10.3390/jcm12196211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/13/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
This study assessed the relationship between head posture displacements and biomechanical parameters during gait and jumping. One hundred male and female students (20 ± 3 yrs) were assessed via the PostureScreen Mobile® app to quantify postural displacements of head rotations and translations including: (1) the cranio-vertebral angle (CVA) (°), (2) anterior head translation (AHT) (cm), (3) lateral head translation in the coronal plane (cm), and (4) lateral head side bending (°). Biomechanical parameters during gait and jumping were measured using the G-Walk sensor. The assessed gait spatiotemporal parameters were cadence (steps/min), speed (m/s), symmetry index, % left and right stride length (% height), and right and left propulsion index. The pelvic movement parameters were (1) tilt symmetry index, (2) tilt left and right range, (3) obliquity symmetry index, (4) obliquity left and right range, (5) rotation symmetry index, and (6) rotation left and right range. The jump parameters measured were (1) flight height (cm), (2) take off force (kN), (3) impact Force (kN), (4) take off speed (m/s), (5) peak speed (m/s), (6) average speed concentric phase (m/s), (7) maximum concentric power (kW), (8) average concentric power (kW) during the counter movement jump (CMJ), and (9) CMJ with arms thrust (CMJAT). At a significance level of p ≤ 0.001, moderate-to-high correlations (0.4 < r < 0.8) were found between CVA, AHT, lateral translation head, and all the gait and jump parameters. Weak correlations (0.2 < r < 0.4) were ascertained for lateral head bending and all the gait and jump parameters except for gait symmetry index and pelvic symmetry index, where moderate correlations were identified (0.4 < r < 0.6). The findings indicate moderate-to-high correlations between specific head posture displacements, such as CVA, lateral head translation and AHT with the various gait and jump parameters. These findings highlight the importance of considering head posture in the assessment and optimization of movement patterns during gait and jumping. Our findings contribute to the existing body of knowledge and may have implications for clinical practice and sports performance training. Further research is warranted to elucidate the underlying mechanisms and establish causality in these relationships, which could potentially lead to the development of targeted interventions for improving movement patterns and preventing injuries.
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Affiliation(s)
- Nabil Saad
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates (I.M.M.)
| | - Ibrahim M. Moustafa
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates (I.M.M.)
- Neuromusculoskeletal Rehabilitation Research Group, RIMHS–Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Amal Ahbouch
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates (I.M.M.)
| | - Nour Mustafa Alsaafin
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates (I.M.M.)
| | - Paul A. Oakley
- Kinesiology and Health Sciences, York University, Toronto, ON M3J 1P3, Canada
- Independent Researcher, Newmarket, ON L3Y 8Y8, Canada
| | - Deed E. Harrison
- CBP Nonprofit (a Spine Research Foundation), Eagle, ID 83616, USA
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Wilartratsami S, Nathasiri L, Vanadurongwan B, Santipas B, Suvithayasiri S, Luksanapruksa P. Relationship between gait parameter and spinal sagittal profiles in asymptomatic subjects. BMC Musculoskelet Disord 2023; 24:559. [PMID: 37422642 DOI: 10.1186/s12891-023-06672-8] [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: 12/16/2022] [Accepted: 06/28/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND To study the gait parameters in asymptomatic volunteers and investigate the correlation between the gait and several radiographic sagittal profiles. METHODS Asymptomatic volunteers (20-50 years of age) were included and allocated into three subgroups depending on pelvic incidence (low, normal, and high). Standing whole spine radiographs and gait analysis data were obtained. The Pearson Coefficient Correlation was used to determine the relationship between the gait and radiographic profiles. RESULTS A total of 55 volunteers (28 male and 27 females) were included. The mean age was 27.35 ± 6.37 years old. The average sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and PI-LL mismatch (PI-LL) were 37.78 ± 6.59, 14.51 ± 9.19 degrees, and 52.29 ± 10.87 degrees and - 0.36 ± 11.41, respectively. The mean velocity and stride of all the volunteers were 119.00 ± 30.12 cm/s and 130.25 ± 7.72 cm, correspondingly. The correlation between each of the radiographical and gait parameters was low (ranging from - 0.24 to 0.26). CONCLUSION Gait parameters were not differenced significantly between each of the PI subgroups in asymptomatic volunteers. Spinal sagittal parameters also showed a low correlation with gait parameters.
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Affiliation(s)
- Sirichai Wilartratsami
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok, 10700, Thailand
| | - Lopburi Nathasiri
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok, 10700, Thailand
| | - Bavornrat Vanadurongwan
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok, 10700, Thailand
| | - Borriwat Santipas
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok, 10700, Thailand
| | | | - Panya Luksanapruksa
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok, 10700, Thailand.
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Segi N, Nakashima H, Ando K, Kobayashi K, Seki T, Ishizuka S, Takegami Y, Machino M, Ito S, Koshimizu H, Tomita H, Hasegawa Y, Imagama S. Spinopelvic Imbalance Is Associated With Increased Sway in the Center of Gravity: Validation of the "Cone of Economy" Concept in Healthy Subjects. Global Spine J 2023; 13:1502-1508. [PMID: 34569350 PMCID: PMC10448103 DOI: 10.1177/21925682211038897] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To investigate the effects of pelvic compensation on standing balance in healthy volunteers. METHODS The 180 healthy volunteers were recruited at a basic health checkup. The inclusion criteria were: 1) age ≥ 65 years, 2) underwent a whole spine radiograph and stabilometry, 3) well-balanced standing posture with a sagittal vertical axis <50 mm, and 4) a visual analog scale of lower back pain of <20 mm. Based on the pelvic incidence (PI) and lumbar lordosis (LL) mismatch, subjects were divided into harmonious (PI-LL ≤ 10°) or unharmonious (PI-LL > 10°) groups. RESULTS Participants in the unharmonious group were significantly older compared with the harmonious group (70.2 ± 4.4 vs. 72.0 ± 4.6 years, P < .01). The PI minus LL values were -2.2° ± 7.5° and 16.6° ± 7.0° in the harmonious and unharmonious groups, respectively (P < .001). Anteroposterior LNG/TIME (average center of pressure sway speed) was significantly greater in the unharmonious group with both open and closed eyes (1.04 ± 0.38 cm/s vs. 1.25 ± 0.47 cm/s, P < .001 and 1.22 ± 0.54 cm/s vs. 1.58 ± 0.77 cm/s, P < .001, respectively). Lateral LNG/TIME was significantly greater in the unharmonious group only with closed eyes (1.24 ± 0.54 cm/s vs. 1.47 ± 0.79 cm/s, P = .03). CONCLUSIONS Healthy elderly subjects with poor spinopelvic harmony had relatively unstable standing balance. The "cone of economy" was demonstrated, showing that unharmonious spinopelvic balance had a non-economic effect on standing.
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Affiliation(s)
- Naoki Segi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Showa Ward, Nagoya, Aichi, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Showa Ward, Nagoya, Aichi, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Showa Ward, Nagoya, Aichi, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Showa Ward, Nagoya, Aichi, Japan
| | - Taisuke Seki
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Showa Ward, Nagoya, Aichi, Japan
| | - Shinya Ishizuka
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Showa Ward, Nagoya, Aichi, Japan
| | - Yasuhiko Takegami
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Showa Ward, Nagoya, Aichi, Japan
| | - Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Showa Ward, Nagoya, Aichi, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Showa Ward, Nagoya, Aichi, Japan
| | - Hiroyuki Koshimizu
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Showa Ward, Nagoya, Aichi, Japan
| | - Hiroyuki Tomita
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Showa Ward, Nagoya, Aichi, Japan
| | - Yukiharu Hasegawa
- Department of Rehabilitation, Kansai University of Welfare Sciences, Kashiwara, Osaka, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Showa Ward, Nagoya, Aichi, Japan
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Ikegami S, Nishimura H, Oba H, Uehara M, Kamanaka T, Hatakenaka T, Miyaoka Y, Fukuzawa T, Hayashi K, Kuraishi S, Munakata R, Horiuchi H, Ishida Y, Nagamine K, Koseki M, Takahashi J. Reliability and validity of gait dynamic balance assessment in adult spinal deformity patients using a two-point trunk motion measuring device. Spine J 2023; 23:1045-1053. [PMID: 37059305 DOI: 10.1016/j.spinee.2023.04.003] [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: 01/11/2023] [Revised: 03/18/2023] [Accepted: 04/07/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND CONTEXT Adult spinal deformity (ASD) patients often complain of walking discomfort. However, dynamic balance evaluation methods of gait in ASD have not been well established. DESIGN Case series study. PURPOSE Characterize the gait of ASD patients using a novel two-point trunk motion measuring device. PATIENT SAMPLE Sixteen ASD patients scheduled for surgery and 16 healthy control subjects. OUTCOME MEASURES Trunk swing width and track length of the upper back and sacrum. METHODS Gait analysis was performed using a two-point trunk motion measuring device on 16 ASD patients and 16 healthy control subjects. Three measurements were taken for each subject, and the coefficient of variation was determined to compare measurement accuracy between the ASD and control groups. Trunk swing width and track length were measured in three dimensions for comparisons between the groups. The relationship among output indices, sagittal spinal alignment parameters, and quality of life (QOL) questionnaire scores was examined as well. RESULTS No significant difference was found for the precision of the device between the ASD and control groups. Compared with controls, the walking style of ASD patients tended to have larger right-left swing of the trunk (+14.0 cm and +23.3 cm at the sacrum and upper back, respectively), larger horizontal plane movement of the upper body (+36.4 cm), less vertical movement (-5.9 cm and -8.2 cm up-down swing at the sacrum and upper back, respectively), and longer gait cycle (+0.13 sec). Regarding QOL in ASD patients, greater right-left/front-back swing of the trunk, greater movement in the horizontal plane, and longer gait cycle were associated with lower QOL scores. Conversely, greater vertical movement was associated with higher QOL. CONCLUSIONS ASD patients had unique gait characteristics, the intensity of which were associated with diminished QOL. The two-point trunk motion measuring device may be reliable and useful for the clinical assessment of balance during gait in ASD patients.
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Affiliation(s)
- Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan; Department of Rehabilitation Medicine, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
| | - Hikaru Nishimura
- Rehabilitation Center, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Hiroki Oba
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Masashi Uehara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Takayuki Kamanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Terue Hatakenaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Yoshinari Miyaoka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan; Department of Rehabilitation Medicine, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Takuma Fukuzawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Koji Hayashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Shugo Kuraishi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Ryo Munakata
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Hiroshi Horiuchi
- Department of Rehabilitation Medicine, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Yuzu Ishida
- Department of Rehabilitation Medicine, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Kohei Nagamine
- Department of Rehabilitation Medicine, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Michihiko Koseki
- Faculty of Textile Science and Technology, Shinshu University, 3-15-1 Tokida, Ueda, Nagano 386-8567, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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Sato K, Tominaga R, Endo T, Miura T, Iwabuchi M, Ito T, Shirado O. The association of dynamic spinal alignment on gait endurance of patients with adult spinal deformity: a cross-sectional study. Spine Deform 2023; 11:463-469. [PMID: 36303021 DOI: 10.1007/s43390-022-00605-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 10/15/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the gait posture of patients with adult spinal deformity (ASD) using a 3-dimensional motion analysis system (3DMAS) and to investigate whether it affects gait endurance. METHODS Fifty-one patients with ASD aged 50 years or older who were admitted to our hospital between March 2016 and March 2018 were included in the study. The subjects completed the 6-min walking test, which is an indicator of gait endurance. Static standing posture was assessed by whole-spine x-ray examination (coronal cobb angle, CCA; sagittal vertical axis, SVA; pelvic tilt, PT; and pelvic incidence minus lumbar lordosis, PI-LL). In addition, the gait posture was evaluated by a 3DMAS (dynamic trunk tilt angle, DTA; and dynamic pelvic tilt angle, DPA). The relationship between standing and gait postures and gait endurance was investigated by multivariable analysis. RESULTS In univariable analysis, SVA, PI-LL, and DTA were associated with gait endurance. Furthermore, in the multivariable analysis, DTA showed the strongest association among the static and dynamic parameters (R2 = 0.61, β = - 0.35, P < 0.05). CONCLUSIONS An association was found between gait posture and gait endurance in patients with ASD. These findings can be useful to health care providers treating patients with ASD. It is advisable to assess the gait posture of patients with ASD because they present postural abnormalities during gait.
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Affiliation(s)
- Keita Sato
- Departments of Rehabilitation/Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, 21-2, Tanisawa-aza-maeda, Kawahigashi, Aizuwakamatsu, Fukushima, 969-3492, Japan.
| | - Ryoji Tominaga
- Departments of Rehabilitation/Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, 21-2, Tanisawa-aza-maeda, Kawahigashi, Aizuwakamatsu, Fukushima, 969-3492, Japan
| | - Tatsuya Endo
- Departments of Rehabilitation/Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, 21-2, Tanisawa-aza-maeda, Kawahigashi, Aizuwakamatsu, Fukushima, 969-3492, Japan
| | - Takuya Miura
- Departments of Rehabilitation/Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, 21-2, Tanisawa-aza-maeda, Kawahigashi, Aizuwakamatsu, Fukushima, 969-3492, Japan
| | - Masumi Iwabuchi
- Departments of Rehabilitation/Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, 21-2, Tanisawa-aza-maeda, Kawahigashi, Aizuwakamatsu, Fukushima, 969-3492, Japan
| | - Toshikazu Ito
- Hokkaido Chitose College of Rehabilitation, Chitose, Hokkaido, Japan
| | - Osamu Shirado
- Departments of Rehabilitation/Orthopaedic and Spinal Surgery, Aizu Medical Center, Fukushima Medical University, 21-2, Tanisawa-aza-maeda, Kawahigashi, Aizuwakamatsu, Fukushima, 969-3492, Japan
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The dynamic sagittal balance: Definition of dynamic spino-pelvic parameters using a method based on gait analysis. World Neurosurg X 2023; 18:100165. [PMID: 36825219 PMCID: PMC9942115 DOI: 10.1016/j.wnsx.2023.100165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Evaluation of sagittal balance parameters is a standard assessment before spine surgery. However, these parameters can change during walking. We aimed to describe the behavior of spino-pelvic parameters during walking in healthy subjects. Material and methods Analyses were performed in 60 healthy subjects. Static spinal sagittal balance parameters were assessed. We performed gait analysis and we used SMART-DX 500® to analyze parameters aimed at defining dynamic sagittal balance, including pelvic tilt angle (PTA), sagittal trunk shift (STS), and trunk angle (TA). We considered rotational and obliquity movements of the pelvis, flexo-extension movements of the hip, trunk, and knees. Analyses were performed in a standing posture and during walking. Results PTA-cycle, PTA-stance, PTA-swing, STS-cycle, STS-stance, and STS-swing showed good-to-excellent internal reliability (ICC = 0.867; ICC = 0.700; ICC = 0.817, respectively). The parameters with the lowest variability were radiographic PI (CV = 16.53%), PTA-stance (CV = 9.55%), and PTA-swing (CV = 17.22%). PT was directly related to PTA-cycle (r = 0.534, p = .027). PI was inversely correlated with trunk flexo-extension range of motion (r = -0.654, p = .004) and dynamic PT (r = -0.489, p = .047). LL and SS were directly related to knee flexo-extension (r = 0.505, p = .039; r = 0.493, p = .045, respectively). SVA was correlated with the trunk obliquity in dynamics (r = 0.529, p = .029). PTA-cycle was directly related to trunk obliquity (r = 0.538, p = .049). STS and TA in the three phases of step were related to the kinematic parameters of the pelvis. TA was related to flexo-extension of the hip and knee. Conclusions Variations of dynamic spino-pelvic parameters occur during walking and modify sagittal balance from a static to a dynamic condition.
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The relationship between spinal alignment and activity of paravertebral muscle during gait in patients with adult spinal deformity: a retrospective study. BMC Musculoskelet Disord 2023; 24:2. [PMID: 36597097 PMCID: PMC9808926 DOI: 10.1186/s12891-022-06121-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Spinal alignment in patients with adult spinal deformity (ASD) changes between rest and during gait. However, it remains unclear at which point the compensated walking posture breaks down and how muscles respond. This study used time-synchronized electromyography (EMG) to investigate the relationship between dynamic spinal alignment and muscle activity during maximum walking duration to reveal compensation mechanisms. METHODS This study collected preoperative three-dimensional gait analysis data from patients who were candidates for corrective surgery for ASD from April 2015 to May 2019. We preoperatively obtained dynamic spinal alignment parameters from initiation to cessation of gait using a motion capture system with time-synchronized surface integrated EMG (iEMG). We compared chronological changes in dynamic spinal alignment parameters and iEMG values 1) immediately after gait initiation (first trial), 2) half of the distance walked (half trial), and 3) immediately before cessation (last trial). RESULTS This study included 26 patients (22 women, four men) with ASD. Spinal sagittal vertical axis distance during gait (SpSVA) increased over time (first vs. half vs. last, 172.4 ± 74.8 mm vs. 179.9 ± 76.8 mm vs. 201.6 ± 83.1 mm; P < 0.001). Cervical paravertebral muscle (PVM) and gluteus maximus activity significantly increased (P < 0.01), but thoracic and lumbar PVM activity did not change. Dynamic spinal alignment showed significant correlation with all muscle activity (cervical PVM, r = 0.41-0.54; thoracic PVM, r = 0.49-0.66; gluteus maximus, r = 0.54-0.69; quadriceps, r = 0.46-0.55) except lumbar PVM activity. CONCLUSION Spinal balance exacerbation occurred continuously in patients with ASD over maximum walking distance and not at specific points. To maintain horizontal gaze, cervical PVM and gluteus maximus were activated to compensate for a dynamic spinal alignment change. All muscle activities, except lumbar PVM, increased to compensate for the spinal malalignment over time.
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Semaan K, Rachkidi R, Saad E, Massaad A, Kawkabani G, Saliby RM, Mekhael M, Abi Karam K, Fakhoury M, Jaber E, Ghanem I, Skalli W, Lafage V, Assi A. Alterations of gait kinematics depend on the deformity type in the setting of adult spinal deformity. 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 2022; 31:3069-3080. [PMID: 36028589 DOI: 10.1007/s00586-022-07348-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 07/13/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To evaluate 3D kinematic alterations during gait in Adult Spinal Deformity (ASD) subjects with different deformity presentations. METHODS One hundred nineteen primary ASD (51 ± 19y, 90F), age and sex-matched to 60 controls, underwent 3D gait analysis with subsequent calculation of 3D lower limb, trunk and segmental spine kinematics as well as the gait deviation index (GDI). ASD were classified into three groups: 51 with sagittal malalignment (ASD-Sag: SVA > 50 mm, PT > 25°, and/or PI-LL > 10°), 28 with only frontal deformity (ASD-Front: Cobb > 20°) and 40 with only hyperkyphosis (ASD-HyperTK: TK > 60°). Kinematics were compared between groups. RESULTS ASD-Sag had a decreased pelvic mobility compared to controls with a decreased ROM of hips (38 vs. 45°) and knees (51 vs. 61°). Furthermore, ASD-Sag exhibited a decreased walking speed (0.8 vs. 1.2 m/s) and GDI (80 vs. 95, all p < 0.05) making them more prone to falls. ASD-HyperTK showed similar patterns but in a less pronounced way. ASD-Front had normal walking patterns. GDI, knee flex/extension and walking speed were significantly associated with SVA and PT (r = 0.30-0.65). CONCLUSION Sagittal spinal malalignment seems to be the driver of gait alterations in ASD. Patients with higher GT, SVA, PT or PI-LL tended to walk slower, with shorter steps in order to maintain stability with a limited flexibility in the pelvis, hips and knees. These changes were found to a lesser extent in ASD with only hyperkyphosis but not in those with only frontal deformity. 3D gait analysis is an objective tool to evaluate functionality in ASD patients depending on their type of spinal deformity. LEVEL OF EVIDENCE I Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
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Affiliation(s)
- Karl Semaan
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Rami Rachkidi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Eddy Saad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Abir Massaad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Georges Kawkabani
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Renée Maria Saliby
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Mario Mekhael
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Krystel Abi Karam
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Marc Fakhoury
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Elena Jaber
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts Et Métiers, Paris, France
| | | | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.
- Institut de Biomécanique Humaine Georges Charpak, Arts Et Métiers, Paris, France.
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Clinical Outcomes of Corrective Fusion Surgery From the Thoracic Spine to the Pelvis for Adult Spinal Deformity at 1, 2, and 5 years Postoperatively. Spine (Phila Pa 1976) 2022; 47:792-799. [PMID: 35194001 DOI: 10.1097/brs.0000000000004347] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To investigate whether patient-reported outcomes (PROs) were consistent at 2 and 5 years after corrective fusion surgery from the thoracic spine to the pelvis in patients with adult spinal deformity (ASD) and to analyze whether revision surgery affected long-term outcomes. SUMMARY OF BACKGROUND DATA PROs up to 2 years after corrective surgeries for ASD have been well-studied, but there are few reports of mid- to long-term results. METHODS We retrospectively analyzed patients with ASD who underwent corrective fusion surgery from the thoracic spine to the pelvis between 2010 and 2015. We investigated radiographic parameters and PROs (Scoliosis Research Society 22r [SRS-22r], Oswestry Disability Index [ODI]) preoperatively and at 1, 2, and 5 years postoperatively, and the correlations between PROs at these time points. We also compared changes in PROs at 5 years in patients who underwent revision surgery and those who did not. RESULTS A total of 131 patients who underwent corrective fusion surgery from the thoracic spine to the pelvis were analyzed. The PROs at 1 and 5 years after surgery showed significant correlations in all SRS-22r domains (function [r = 0.620], pain [r = 0.577], self-image [r = 0.563], mental health [r = 0.589], subtotal [r = 0.663], and ODI [r = 0.654]). The PROs at 2 and 5 years after surgery showed significantly strong correlations in all domains (function [r = 0.715], pain [r = 0.678], self-image [r = 0.653], mental health [r = 0.675], subtotal [r = 0.741], and ODI [r = 0.746]). There were no significant differences in the change in PROs at 5 years in any domain in patients who underwent revision surgery (all P > 0.05). CONCLUSION One-year postoperative PROs improved significantly. Two-year PROs correlated strongly with 5-year postoperative PROs, indicating that 2-year PROs can predict longer term outcomes. The need for revision surgery did not influence the mid- to long-term clinical outcomes of corrective fusion surgery for ASD.Level of Evidence: 3.
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Chronological Evaluation of Gait Ability and Posture Balance after Adult Spinal Deformity Surgery. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094285] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Adult spinal deformity (ASD) is highly prevalent in persons older than 65 years, affecting more than 30% of the total population. There are many important reports that describe excellent postoperative results for ASD surgery. However, there is no report that describes a chronological evaluation of gait ability and spinal balance after ASD surgery. The present prospective study aimed to determine the recovery time of gait and spinal balance ability after adult spinal deformity (ASD) surgery. Patients with ASD (n = 25: mean age, 73.0 years) who underwent corrective surgery and preoperative and postoperative gait and spinal balance ability evaluation. Spinal radiographs and gait analysis data (static balance; single-leg standing, dynamic balance; time-up and go test, gait ability; 10 m walk velocity) were acquired preoperatively, 1 month, 6 months, and 12 months after surgery. The radiographic parameters of the spine and pelvis (lumbar lordosis; LL, pelvic tilt; PT, sagittal vertical axis; SVA, pelvic incidence; PI) were measured. The mean postoperative SVA, LL, PT, and PI-LL became 30.0 mm, 50.1 degrees, 14.1 degrees, and 0.35 degrees, respectively. Preoperatively, all spinal balance and gait ability were worse than the normal threshold (one-leg standing; 14.2 s vs. 15.0 s, time-up and go test; 13.9 s vs. 13.5 s, 10-m walk speed; 0.91 m/s vs. 1.00 m/s). At 12 months after surgery, all spinal balance and gait ability became normal or improved (single-leg standing; 14.7 s, time-up and go test; 11.0 s, 10-m walk speed; 1.09 m/s). The ODI at one-year follow-up improved from 46.8 ± 12.6% to 27.8 ± 18.1%. In conclusion, gait and spinal balance analysis revealed that ASD patients could not recover gait and spinal balance ability one month after surgery. At 12 months after surgery, gait ability and dynamic spinal balance became better than preoperative levels. However, the static spinal balance was at the same level as that of preoperative status.
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Cost-effectiveness of Corrective Fusion Surgeries for Adult Spinal Deformities: A Comparison by Operative Method. Spine (Phila Pa 1976) 2021; 46:1249-1257. [PMID: 34435988 DOI: 10.1097/brs.0000000000004004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of this study was to summarize the cost-effectiveness of surgical treatment for adult spinal deformity (ASD) according to the operative method over 2 years postoperatively. SUMMARY OF BACKGROUND DATA Extensive corrective fusion surgery for ASD requires numerous expensive implants, greatly contributing toward the national medical expenses. Previous national studies reported high complication rates in spinal surgeries using instrumentation. However, the cost-effectiveness of such procedures has not been scrutinized. METHODS In total, 173 ASD patients (151 women; mean age 69.1 years) who underwent corrective fusion between 2010 and 2017 were included. Cost-effectiveness was evaluated according to the cost of obtaining 1 quality-adjusted life year (QALY). Patients were divided into three groups: the "corrective fusion surgery using multiple Grade 2 osteotomy" (Grade-2) group, three-column osteotomy group (three-column), and lateral lumbar interbody fusion (LLIF) group. RESULTS The average medical cost for the initial surgery was USD 72,240, and that during the 2 years after the initial surgery was USD 76,294. The medical expenses for the initial surgery and those over the 2 years were higher in the LLIF group. The cumulative improvement in QALY over the 2 years did not significantly differ among the groups (0.13, 0.15, and 0.18 in the Grade-2, three-column, and LLIF groups, respectively). Cost/QALY 2 years after the surgery was USD 509,370, 518,406, and 463,798 in the Grade-2, three-column, and LLIF groups, respectively. CONCLUSION We summarized the medical costs and cost-effectiveness of three different surgical methods for ASD in patients with different backgrounds over 2 years postoperatively. The medical expense for the initial surgery was highest in the LLIF group, and the cumulative improvement in QALY over the 2 years tended to be higher in the LLIF group, but the difference was not significant; the overall cost-effectiveness was lowest in the LLIF group.Level of Evidence: 3.
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Murata K, Endo K, Aihara T, Suzuki H, Matsuoka Y, Nishimura H, Takamatsu T, Yamamoto K. The impact of sagittal imbalance on walking in patients with lumbar spinal canal stenosis. J Orthop Surg (Hong Kong) 2021; 29:23094990211010522. [PMID: 33926315 DOI: 10.1177/23094990211010522] [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: 11/15/2022] Open
Abstract
PURPOSE Gait and posture disorder severely impedes the quality of life of affected patients with lumbar spinal canal stenosis (LSCS). Despite the major health concern, there is a paucity of literature about the relationships among spatiotemporal gait parameters and spinal sagittal parameters. This is a cross sectional study performed in a single tertiary referral center to determine the relationships among spatiotemporal gait parameters and spinal sagittal parameters in patients with LSCS. METHODS A total of 164 consecutive patients with LSCS, 87 men and 77 women with mean age of 70.7 years, were enrolled. Spatiotemporal gait parameters were studied using a gait analysis system. Spinal sagittal parameters were studied including sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic inclination (PI), and pelvic tilt (PT) both in the neutral and stepped positions. RESULTS SVA was significantly larger in the stepped position than in the neutral position (neutral position, 72.5 mm; stepped position, 96.8 mm; p = 0.003). Parameters regarding the pelvis exhibited significant differences, which could represent pelvic anteversion in the stepped position. By stepwise multiple regression analysis, the prediction models, containing SVA (neutral) and PT (stepped) for double supporting phase, exhibited statistical significance, and accounted for approximately 50% of the variance. CONCLUSIONS The present study provides statistically established evidence of correlation among spatiotemporal gait parameters and spinal sagittal parameters. Differences between sagittal parameters in neutral and stepped position may stand for the postural control during gait cycle, and increased SVA in neutral position and increased PT in stepped position may correlate with prolonged double supporting phase.
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Affiliation(s)
- Kazuma Murata
- Department of Orthopedic Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Kenji Endo
- Department of Orthopedic Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Takato Aihara
- Department of Orthopedic Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Orthopedic Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Yuji Matsuoka
- Department of Orthopedic Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Hirosuke Nishimura
- Department of Orthopedic Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Taichiro Takamatsu
- Department of Orthopedic Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, 13112Tokyo Medical University, Tokyo, Japan
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Arima H, Yamato Y, Hasegawa T, Togawa D, Yoshida G, Yasuda T, Banno T, Oe S, Ushirozako H, Yamada T, Watanabe Y, Ide K, Matsuyama Y. Improvements in physical functionality in elderly patients with spinal deformity after corrective fusion surgery: a gait analysis. J Neurosurg Spine 2021; 35:235-242. [PMID: 34087789 DOI: 10.3171/2020.10.spine201323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/29/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Extensive corrective fusion surgery was performed on elderly patients with adult spinal deformity (ASD) to improve abnormal posture. Varying improvements in postoperative walking function were expected owing to differences in muscular strength and bone quality between patients in their 40s and those over 75 years of age. The purpose of this study was to compare preoperative and postoperative gait posture and physical functionality in elderly patients with ASD who underwent extensive corrective fusion to the thoracic spine. METHODS A prospectively maintained surgical database was reviewed for patients with ASD who underwent corrective fusion surgery (thoracic spine to pelvis) between 2011 and 2016. The cohort was divided into three age groups: nonelderly (40-64 years), young-old (65-74 years), and old-old (> 75 years). Patients underwent a 4-m walk test preoperatively and 2 years postoperatively to measure gait-trunk tilt angle and walking speed (meters per minute). RESULTS Among 291 patients with ASD who underwent corrective fusion surgery, 56 patients (14 men and 42 women; mean age 68.8 years) were included. Mean preoperative gait-trunk tilt angle (12.9° vs 5.2°, p < 0.01) and walking speed (41.2 m/min vs 45.7 m/min, p < 0.01) significantly improved postoperatively. Intergroup analysis revealed that the mean preoperative gait-trunk tilt angles in the nonelderly (n = 13), young-old (n = 28), and old-old (n = 15) groups were 11.9°, 10.0°, and 19.3°, respectively; postoperatively, these improved to 4.5°, 4.5°, and 7.2°, respectively. Mean preoperative walking speeds of 47.9, 40.0, and 37.7 m/min improved to 52.4, 44.8, and 41.5 m/min postoperatively in the nonelderly, young-old, and old-old groups, respectively. There were no statistically significant differences in degree of improvement in gait-trunk tilt angle and walking speed among groups. CONCLUSIONS Extensive corrective fusion surgery improved the postoperative walking posture of patients with ASD. Statistical analysis of gait measurements demonstrated intergroup equivalence, indicating comparable improvement in physical functionality in elderly and middle-aged patients after corrective fusion surgery.
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Affiliation(s)
| | - Yu Yamato
- 1Department of Orthopaedic Surgery and
- 2Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu; and
| | | | - Daisuke Togawa
- 3Department of Orthopaedic Surgery, Kinki University Nara Hospital, Ikoma, Japan
| | | | | | | | - Shin Oe
- 1Department of Orthopaedic Surgery and
- 2Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu; and
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Haddas R, Wood A, Mar D, Derman P, Lieberman I. Reporting and tracking objective functional outcome measures: implementation of a summary report for gait and balance measures. Spine J 2021; 21:1193-1204. [PMID: 33631256 DOI: 10.1016/j.spinee.2021.02.015] [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: 08/06/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 02/03/2023]
Abstract
The aim of this manuscript is to describe knowledge gaps in the literature, future directions, and emerging applications of gait and balance analysis in spine surgery with regard to functional outcomes measurement. Functional outcome measurement has been established as a useful clinical and research investigational tool in musculoskeletal disease. Evidence currently supports its use in the diagnosis, treatment, and outcome measurement of multiple musculoskeletal disease states, including spinal disease, and its usefulness continues to grow as literature develops. Gait and balance analysis has proven to be broadly applicable, but most clinicians remain unfamiliar and untrained in its usage. The logistical and communication barriers are also described with the potential solutions that are on the near horizon of research. This article describes our methodology for improving conveyance of functional outcome measures in spine surgery. Additionally, we provide a case example of an adult patient with spinal deformity who is examined pre and post operatively using our methodology.
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Affiliation(s)
| | - Addison Wood
- UNT Health Science Center, Fort Worth, TX, USA; John Peter Smith Hospital, Fort Worth, TX, USA
| | - Damon Mar
- Texas Back Institute, Plano, TX, USA
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22
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Dynamic sagittal alignment and compensation strategies in adult spinal deformity during walking. Spine J 2021; 21:1059-1071. [PMID: 33621665 DOI: 10.1016/j.spinee.2021.02.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Radiographic evaluation in adult spinal deformity (ASD) offers no information on spinopelvic alignment and compensation during dynamic conditions. Motion analysis offers the potential to bridge the gap between static radiographic and dynamic alignment measurement, increasing our understanding on how ASD impacts function. PURPOSE This study aimed to explore the changes in sagittal alignment and compensation strategies in ASD between upright standing and walking, compared to control subjects and within different sagittal alignment groups. Ten patients were measured pre- and six months postoperatively to explore the impact of surgical alignment correction on gait. STUDY DESIGN Prospective study. SAMPLE SIZE Full protocol: 58 ASD and 20 controls; Spinal kinematic analysis: 43 ASD and 18 controls; Postoperative analysis: 10 ASD. OUTCOME MEASURES Standing and walking sagittal spinopelvic (thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvis), and lower limb kinematics, spinopelvic changes between standing and walking (∆ ie, difference between mean dynamic and static angle), lower limb kinetics, spatiotemporal parameters, balance (BESTest), patient-reported outcome scores (SRS-22r, ODI, and FES-I) and radiographic parameters. METHODS Motion analysis was used to assess the standing and walking spinopelvic and lower limb kinematics, as well as the lower limb kinetics during walking. All parameters were compared between controls and patients with ASD, divided in three groups based on their sagittal alignment (ASD 1: decompensated sagittal malalignment; ASD 2: compensated sagittal malalignment; ASD 3: scoliosis and normal sagittal alignment). Ten patients were reassessed 6 months after spinal corrective surgery. Continuous kinematic and kinetic data were analyzed through statistical parametric mapping. RESULTS All patient groups walked with increased forward trunk tilt (∆SVA=41.43 mm, p<.001) in combination with anterior pelvic tilt (∆Pelvis=2.58°, p<.001) compared to standing, as was also observed in controls (∆SVA=37.86 mm, p<.001; ∆Pelvis=1.62°, p=.012). Patients walked with increased SVA, in combination with decreased LL and alterations in lower limb kinematics during terminal stance and initial swing, as well as altered spatiotemporal parameters. Subgroup analysis could link these alterations in gait to sagittal spinopelvic malalignment (ASD 1 and 2). After surgical correction, lower limb kinematics and spatiotemporal parameters during gait were not significantly improved. CONCLUSIONS To compensate for increased trunk tilt and pelvic anteversion during walking, patients with sagittal malalignment show altered lower limb gait patterns, which have previously been associated with increased risk of falling and secondary lower limb pathology. Since surgical correction of the deformity did not lead to gait improvements, further research on the underlying mechanisms is necessary to improve our understanding of how ASD impacts function.
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Di Bartolomeo A, Ricciardi L, Miscusi M, Serrao M, Raco A. Letter to the editor regarding "Representative dynamic ranges of spinal alignment during gait in patients with mild and severe adult spinal deformities" by Mar etal. Spine J 2021; 21:1042-1043. [PMID: 34053503 DOI: 10.1016/j.spinee.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/01/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Alessandro Di Bartolomeo
- Division of Neurosurgery, AOU Sant'Andrea, Department of NESMOS, Sapienza University, Rome, Italy.
| | - Luca Ricciardi
- Division of Neurosurgery, AOU Sant'Andrea, Department of NESMOS, Sapienza University, Rome, Italy
| | - Massimo Miscusi
- Division of Neurosurgery, AOU Sant'Andrea, Department of NESMOS, Sapienza University, Rome, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza, University of Rome, Italy
| | - Antonino Raco
- Division of Neurosurgery, AOU Sant'Andrea, Department of NESMOS, Sapienza University, Rome, Italy
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Haddas R, Wood A, Lieberman I, Derman PB. Assessing the cone of economy in patients with spinal disease using only a force plate: an observational retrospective cohort 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 2021; 30:2504-2513. [PMID: 33877453 DOI: 10.1007/s00586-021-06836-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 03/15/2021] [Accepted: 04/03/2021] [Indexed: 11/24/2022]
Abstract
STUDY DESIGN This is a retrospective cohort with multiple regression modeling. OBJECTIVE The aim is to develop a new method for estimating cone of economy (CoE) using a force plate rather than traditional motion capture. BACKGROUND Currently, most spinal deformity surgeons rely on static radiographic parameters for alignment, balance, and outcomes data alongside patient-reported outcome measures. The CoE, the stable region of upright posture, can be objectively measured to determine the efficiency and balance of the spine. Motion capture technology is currently used to collect data to calculate CoE, but this requires expensive and complex equipment, which is a barrier to widespread adoption and clinical use of CoE measurements. Force plates, which measure pressure, are less expensive and can be used in a clinical setting. METHODS Motion capture and a force plate were used to quantify the CoE of 473 subjects (423 spinal surgical candidates; 50 healthy controls; 271 females; age: 58.60 ± 15.27; height: 1.69 ± 0.13; weight: 81.07 ± 20.91), and a linear multiple regression model was used to predict CoE using force plate data in a human motion laboratory setting. Patients were required to stand erect with feet together and eyes open in their self-perceived balanced and natural position for a full minute while measures of sway and center of pressure (CoP) were recorded. RESULTS The CoP variable regression model successfully predicted CoE measurements. The variables that were used to predict vertical CoE were CoP coronal sway, CoP sagittal sway, and CoP total sway in several combinations. The coefficient of determination for the head total sway model indicated a 87.0% correlation (F(3,469) = 1044.14, p < 0.001). The coefficient of determination for the head sagittal sway model indicated a 69.2% correlation (F(3,469) = 351.70, p < 0.001). The coefficient of determination for the head coronal sway model indicated a 85.2% correlation (F(3,469) = 899.27, p < 0001). CONCLUSION Cone of economy was estimated from force plate data using center of pressure with high correlation without the use of motion capture in healthy controls and a variety of spine patients. This could lower the entry burden for measurement of the CoE in patients, enabling widespread use. This would provide surgeons objective global balance data, along with Haddas' CoE classification system, that could assist with surgical decision-making and facilitate objective monitoring surgical outcomes.
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Affiliation(s)
- Ram Haddas
- Texas Back Institute, 6020 West Parker Road, Plano, TX, 75093, USA.
| | - Addison Wood
- UNT Health Science Center, Fort Worth, TX, USA.,John Peter Smith Hospital, Fort Worth, TX, USA
| | - Isador Lieberman
- Texas Back Institute, 6020 West Parker Road, Plano, TX, 75093, USA
| | - Peter B Derman
- Texas Back Institute, 6020 West Parker Road, Plano, TX, 75093, USA
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25
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Representative dynamic ranges of spinal alignment during gait in patients with mild and severe adult spinal deformities. Spine J 2021; 21:518-527. [PMID: 32966908 DOI: 10.1016/j.spinee.2020.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Surgical correction strategies for adult spinal deformity (ASD) relies heavily on radiographic alignment goals, however, there is often debate regarding degree of correction and how static alignment translates to physical ability in daily life. Kinematic analysis has the potential to improve the concept of ideal spinal alignment by providing clinically meaningful estimates of dynamic changes in spinal alignment during activities of daily life. PURPOSE Estimate representative dynamic ranges of spinal alignment during gait among ASD patients using 3D motion tracking; compare dynamic alignment between mild and severe deformity patients and to healthy adults. STUDY DESIGN/SETTING Retrospective review at a single institution. PATIENT SAMPLE Fifty-two ASD patients and 46 healthy adults. OUTCOME MEASURES Radiographic alignment, kinematic spine motion, spatiotemporal gait measures, patient reported outcomes (VAS pain, ODI, SRS-22r). METHODS Spinal alignment was assessed radiographically and during standing and overground walking tests. Dynamic alignment was initialized by linking radiographic alignment to kinematic alignment during standing and at initial heel contact during gait. Dynamic changes in maximums and minimums during gait were made relative to initial heel contact for each gait cycle. Total range-of-motion (RoM) was measured for both ASD and healthy subjects. Dynamic alignment measures included coronal and sagittal vertical axes (CVA, SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), and pelvic tilt (PT). ASD patient's deformities were classified as either Mild or Severe based on the SRS-Schwab ASD classification. RESULTS Severe ASD patients had significantly larger dynamic maximum and minimums for SVA, TPA, LL, and PT (all p<.05) compared with Mild ASD patients. ASD patients exhibited little difference in dynamic alignment compared with healthy subjects. Only PT had a significant difference in dynamic RoM compared with healthy (p<.001). CONCLUSIONS Mild and Severe ASD patients exhibited similar global dynamic alignment measures during gait and had comparable RoM to healthy subjects except with greater PT and reduced spatiotemporal performance which may be key compensatory mechanisms for dynamic stabilization.
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Park HY, Kim YH, Kim SI, Han SB, Ha KY. Two different types of postoperative sagittal imbalance after long instrumented fusion to the sacrum for degenerative sagittal imbalance. J Neurosurg Spine 2020; 33:613-622. [PMID: 32590350 DOI: 10.3171/2020.4.spine20153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Few studies have addressed that dynamic sagittal imbalance can develop distal to the spinal fusion and cause sagittal malalignment, unlike proximal junctional kyphosis (PJK) in the proximal portion. The purpose of this study was to investigate risk factors between the 2 different types of postoperative sagittal imbalance after long fusion to the sacrum for the treatment of degenerative sagittal imbalance (DSI). METHODS Eighty patients who had undergone surgical correction for DSI were included. Radiographic measurements included spinopelvic parameters on whole-spine plain radiographs and degeneration of paravertebral muscles on MRI. Univariate and multivariate analyses for clinical and radiological factors were conducted for respective risk factors. In subgroup analyses, the 2 different types of postoperative sagittal imbalance were directly compared. RESULTS Forty patients (50%) developed postoperative sagittal imbalance; of these patients, 22 (55.0%) developed static proximal kyphosis from PJK, and 18 patients (45.0%) developed dynamic sagittal imbalance without PJK. The independent risk factors in proximal kyphosis were greater postoperative pelvic tilt (HR 1.11) and less change in sacral slope (SS) (HR 1.09), whereas there were more fusion levels (HR 3.11), less change in SS (HR 1.28), and less change in thoracic kyphosis (HR 1.26) in dynamic sagittal imbalance. Directly compared with the proximal kyphosis group, dynamic sagittal imbalance was more commonly found in patients who had less correction of sagittal parameters as well as fatty atrophy of the paravertebral muscles. Clinical outcomes in the dynamic sagittal imbalance group were superior to those in the proximal kyphosis group. CONCLUSIONS Optimal correction of sagittal alignment should be considered in long instrumented fusion for DSI, because insufficient correction might cause one of 2 different types of postoperative sagittal imbalance at different sites of decompression. Dynamic sagittal imbalance compared with proximal kyphosis was significantly associated with less correction of sagittal alignment, in conjunction with more fusion levels and degeneration of the paravertebral muscles.
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Affiliation(s)
- Hyung-Youl Park
- 1Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Young-Hoon Kim
- 2Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul; and
| | - Sang-Il Kim
- 2Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul; and
| | - Sung-Bin Han
- 1Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Kee-Yong Ha
- 3Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
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Haddas R, Villarreal J, Lieberman IH. Kinematic comparison of the use of walking sticks versus a rolling walker during gait in adult degenerative scoliosis patients. Spine Deform 2020; 8:717-723. [PMID: 32124399 DOI: 10.1007/s43390-020-00084-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/29/2019] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A repeated-measurement, single-center, prospective study. OBJECTIVE To compare the spatiotemporal and kinematic data using gait analysis in adult degenerative scoliosis (ADS) patients using walking sticks (WS) versus rolling walkers (RW). ADS patients undergo compensatory changes that can result in an altered gait pattern. RW are frequently prescribed, but result in a forward flexed kyphotic posture during ambulation. Gait using WS allows for more upright alignment in ADS patients. METHODS Fifty-three ADS patients with symptomatic degenerative scoliosis performed over-ground walking at self-selected speed with WS and with a RW. Trunk and lower extremity angles along with spatiotemporal parameters were measured and compared. RESULTS When using WS, patients exhibited less flexion at the head (WS: - 4.8° vs. RW: 11.0°, p = 0.001), and lumbar spine (WS: - 0.9° vs. RW: 4.2°, p = 0.001); while there was significantly more extension, of the cervical spine (WS: - 1.6° vs. RW: - 7.4°, p = 0.002) when using the RW. At the initial contact phase of gait, patients using WS showed decreased flexion at the ankle (WS 0.7° vs. RW: 3.8°, p = 0.018), knee (WS: 0.3° vs. RW: 4.8°, p = 0.001), hip (WS: 22.6° vs. RW: 27.3°, p = 0.001), and pelvis (WS: 10.2° vs. RW: 14.8°, p = 0.001). In contrast, the use of WS resulted in slower ambulation (WS: 0.6 m/s vs. RW: 0.7 m/s, p = 0.001). CONCLUSIONS In ADS patients who have not undergone surgical correction, the use of WS resulted in a more upright posture, which may be more beneficial to the compensatory changes that lead to gait disturbance in ADS patients. Ambulation using WS resulted in slower gait versus a RW, due to the momentum induced by the forward flexed posture when using a RW. We recommend the use of WS for patients with ADS as it improves gait kinematics and may be a safer option.
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Affiliation(s)
- Ram Haddas
- Texas Back Institute, 6020 West Parker Road, Plano, TX, 75093, USA.
| | - Jaime Villarreal
- Texas Back Institute, 6020 West Parker Road, Plano, TX, 75093, USA
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Morozumi M, Ando K, Kobayashi K, Seki T, Ishizuka S, Machino M, Tanaka S, Ito S, Kanbara S, Inoue T, Ishiguro N, Hasegawa Y, Imagama S. Relationship between lumbopelvic discordance and locomotive syndrome in a middle-aged community-living population: The Yakumo study. J Orthop Sci 2020; 25:693-699. [PMID: 31759838 DOI: 10.1016/j.jos.2019.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/09/2019] [Accepted: 09/18/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Locomotive syndrome (LS) affects the quality and activities of daily living. Although spinal sagittal balance influences LS, no report elucidated the relationship between LS risk and lumbopelvic discordance. This study aimed to investigate the relationship between lumbopelvic discordance and LS in a middle-aged community. METHODS The subjects (n = 135) were divided into three groups based on the LS risk stage, which was evaluated through spinopelvic sagittal alignment and lumbopelvic mismatch prevalence (Pelvic incidence-Lumbar lordosis >10°:PI-LL mismatch).Then, the subjects were divided into two groups (lumbopelvic matched and mismatched groups) and analyzed based on the demographic data, physical test, stabilometry, and body pain using the visual analog scale. RESULTS There were 76, 37 and 22 subjects in stages 0, 1, and 2, respectively. The pelvic incidence-lumbar lordosis (PI-LL) mismatched group had a higher prevalence in LS risk stage 2 than in LS risk stage 0. The prevalence of PI-LL mismatch was significantly different among the groups. Post hoc test revealed the differences in spinopelvic alignment among the stages. In each LS risk stage, the degree of PI-LL was significantly higher in stage 2 than that in stages 0 and 1. On comparing the PI-LL matched (n = 67) and mismatched groups (n = 68) with a stabilometer, the envelopment area tracing by the movement of the center of pressure and locus length/second was greater in the PI-LL mismatched group than that in the PI-LL matched group with/without eyes opened. CONCLUSIONS The prevalence of LS risk stage 2 was more frequently observed in the PI-LL mismatched group. The degree of PI-LL was evaluated through the LS risk stages. Physical dysfunction in the PI-LL mismatched group was related to trunk imbalance based on stabilometry. These findings will help manage LS and PI-LL mismatched subjects.
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Affiliation(s)
- Masayoshi Morozumi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Shinya Ishizuka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Masaaki Machino
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Satoshi Tanaka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Sadayuki Ito
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Shunsuke Kanbara
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Taro Inoue
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yukiharu Hasegawa
- Department of Orthopaedic Surgery, Kansai University of Welfare Sciences, 3-11-1, Asahigaoka, Kashihara, Osaka, 5820026, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
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Laratta JL, Glassman SD, Atanda AA, Dimar JR, Gum JL, Crawford CH, Bratcher K, Carreon LY. The Berg balance scale for assessing dynamic stability and balance in the adult spinal deformity (ASD) population. JOURNAL OF SPINE SURGERY 2019; 5:451-456. [PMID: 32042995 DOI: 10.21037/jss.2019.09.15] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Adult spinal deformity (ASD) is a prevalent condition in individuals over the age of 65; leading to impaired standing balance and abnormal gait patterns. This functional impairment may be due to the fixed sagittal or coronal malalignment; associated spinal stenosis or deconditioning. The Berg balance scale (BBS) was developed to measure balance by assessing the performance of functional tasks. The purpose of this study is to determine if BBS is a useful metric for evaluating functional status in ASD patients. Methods ASD patients who required fusion from the thoracic spine to the pelvis from 2014 to 2016 were enrolled and asked to complete the BBS prior to and six months after surgery. BBS were obtained by a certified physical therapist. Standard demographic; radiographic and surgical data were collected. The Oswestry disability index (ODI), EuroQOL-5D and numeric rating scales (0 to 10) for back and leg pain were assessed at baseline and post-intervention. Results Of 21 patients enrolled; 19 completed pre- and post-surgery BBS. The mean age was 59.8±13.3 years with 14 females. There was a statistically significant improvement in all outcome scores and radiographic parameters after surgery; but no difference in BBS. Only one patient had a BBS score low enough to be considered a medium fall risk. There was no difference in the pre-op BBS scores in the four patients that had revision surgery compared to those that did not. Conclusions In this small pilot study; BBS did not appear to be associated with measures of clinical and radiographic improvement in ASD patients. The test was also potentially problematic in that it has a ceiling effect and required significant time with a trained physical therapist for administration. Continued effort to identify a viable measure of balance dysfunction in ASD patients is warranted.
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Affiliation(s)
- Joseph L Laratta
- Norton Leatherman Spine Center, Louisville, KY, USA.,Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Steven D Glassman
- Norton Leatherman Spine Center, Louisville, KY, USA.,Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | | | - John R Dimar
- Norton Leatherman Spine Center, Louisville, KY, USA.,Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Jeffrey L Gum
- Norton Leatherman Spine Center, Louisville, KY, USA.,Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Charles H Crawford
- Norton Leatherman Spine Center, Louisville, KY, USA.,Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
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Kamata K, Ozawa H, Sekiguchi Y, Aizawa T, Izumi S, Itoi E. Spino-pelvic- lower extremity balance during walking in elderly patients with spinal kyphosis. J Orthop Sci 2019; 24:793-797. [PMID: 30738700 DOI: 10.1016/j.jos.2019.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/21/2018] [Accepted: 01/15/2019] [Indexed: 02/09/2023]
Abstract
BACK GROUND Patients with spinal kyphosis were radiographically evaluated while standing. However, the spino-pelvic alignment during walking is different. This study examined the spino-pelvic-lower extremity alignment during walking by a three-dimensional (3D) motion analysis. METHODS Twenty-six patients with a sagittal vertical axis of ≥4 cm (male: female, 5:21; average age, 66 years) were evaluated. Using a 3D motion capture system, the trunk and pelvic anterior inclination angles, hip and knee joint angles were measured during a 3-min walk. The correlation coefficient between the change of the trunk anterior inclination angle and each parameter at the beginning of walking was calculated, and those parameters were compared with radiographic measurements. RESULTS The patients were divided into two groups according to the change of the trunk anterior inclination angle: the large change group included 14 patients with an increase of ≥5° between the beginning and end of the 3-min walk; the small change group included 12 patients with an increase of <5°. The pelvic anterior inclination angle showed a significant difference between the two groups at the first gait cycles. The pelvic anterior inclination angle and the hip joint angle in the large change group showed a significant difference between the first and last cycles. The correlation coefficient revealed a significant association between the change in the trunk anterior inclination angle and the pelvic anterior inclination angle at the beginning of walking. There were no significant differences between the two groups in any radiographic spino-pelvic parameters. CONCLUSIONS There were two types of patients with spinal kyphosis: patients with a small pelvic anterior inclination angle at the beginning of walking showed slight progression in their trunk anterior inclination, whereas those with a large pelvic angle showed a large degree of progression in their pelvic and trunk inclination during walking.
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Affiliation(s)
- Kumi Kamata
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine. 1-1 Seiryomachi Aobaku, Sendai, Miyagi, 980-8574, Japan; Department of Orthopaedic Surgery, Iwaki Kyoritsu Hospital. 16 Utigo Mimayamachi Kusehara, Iwakishi, Fukushima, 973-8555, Japan
| | - Hiroshi Ozawa
- Department of Orthopaedic Surgery, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro Miyaginoku, Sendai, Miyagi, 983-8536, Japan.
| | - Yusuke Sekiguchi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Biomedical Engineering, 2-1 Seiryomachi Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine. 1-1 Seiryomachi Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Shinichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Biomedical Engineering, 2-1 Seiryomachi Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine. 1-1 Seiryomachi Aobaku, Sendai, Miyagi, 980-8574, Japan
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The Change in Sway and Neuromuscular Activity in Adult Degenerative Scoliosis Patients Pre and Post Surgery Compared With Controls. Spine (Phila Pa 1976) 2019; 44:E899-E907. [PMID: 30830047 DOI: 10.1097/brs.0000000000003009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE The purpose of this study is to quantify the extent of change in sway associated with maintaining a balanced posture within the cone of economy (CoE), in a group of adult degenerative scoliosis (ADS) patients' pre and postsurgery and compare them to matched non-scoliotic controls. SUMMARY OF BACKGROUND DATA Patients with spinal deformities adopt a variety of postural changes in the spine, pelvis, and lower extremities in their effort to compensate for the anterior shift in the gravity line. ADS patients are known to exhibit an increased sway within their CoE. Greater sway expends more energy while standing when compared with healthy controls. Spinal alignment surgery has been shown to improve sagittal vertical axis and balance. METHODS Thirty-three ADS patients and performed a series of functional balance tests a week before and 3 months after surgery along with 20 non-scoliotic control. RESULTS ADS patients demonstrated more initial CoM (P = 0.001) and head (P = 0.011) displacements. Postoperatively ADS patients exhibited less CoM sway (P = 0.043) and head sway (P = 0.050), in comparison to their presurgery measures. Postsurgical ADS patients demonstrated more CoM (P = 0.002) and head (P = 0.012) displacements and increased muscle activity in comparison to non-scoliotic controls. CONCLUSION Surgical alignment reduced the amount of sway, reduced the center of mass displacement, and reduced spine and lower extremity energy expenditure in ADS' patients. In symptomatic preoperative ADS patients, sagittal sway increased along with greater lumbar spine and lower extremity neuromuscular activity in comparison to a non-scoliotic control. Although surgical alignment improved ADS functional parameters during a dynamic balance test, these parameters approached but did not fully achieve non-scoliotic control parameters when measured 3 months after surgery. LEVEL OF EVIDENCE 3.
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Bailey JF, Matthew RP, Seko S, Curran P, Chu L, Berven SH, Deviren V, Burch S, Lotz JC. ISSLS PRIZE IN BIOENGINEERING SCIENCE 2019: biomechanical changes in dynamic sagittal balance and lower limb compensatory strategies following realignment surgery in adult spinal deformity patients. 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; 28:905-913. [PMID: 30826876 PMCID: PMC6536471 DOI: 10.1007/s00586-019-05925-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 02/08/2023]
Abstract
STUDY DESIGN A longitudinal cohort study. OBJECTIVE To define a set of objective biomechanical metrics that are representative of adult spinal deformity (ASD) post-surgical outcomes and that may forecast post-surgical mechanical complications. Current outcomes for ASD surgical planning and post-surgical assessment are limited to static radiographic alignment and patient-reported questionnaires. Little is known about the compensatory biomechanical strategies for stabilizing sagittal balance during functional movements in ASD patients. METHODS We collected in-clinic motion data from 15 ASD patients and 10 controls during an unassisted sit-to-stand (STS) functional maneuver. Joint motions were measured using noninvasive 3D depth mapping sensor technology. Mathematical methods were used to attain high-fidelity joint-position tracking for biomechanical modeling. This approach provided reliable measurements for biomechanical behaviors at the spine, hip, and knee. These included peak sagittal vertical axis (SVA) over the course of the STS, as well as forces and muscular moments at various joints. We compared changes in dynamic sagittal balance (DSB) metrics between pre- and post-surgery and then separately compared pre- and post-surgical data to controls. RESULTS Standard radiographic and patient-reported outcomes significantly improved following realignment surgery. From the DSB biomechanical metrics, peak SVA and biomechanical loads and muscular forces on the lower lumbar spine significantly reduced following surgery (- 19 to - 30%, all p < 0.05). In addition, as SVA improved, hip moments decreased (- 28 to - 65%, all p < 0.05) and knee moments increased (+ 7 to + 28%, p < 0.05), indicating changes in lower limb compensatory strategies. After surgery, DSB data approached values from the controls, with some post-surgical metrics becoming statistically equivalent to controls. CONCLUSIONS Longitudinal changes in DSB following successful multi-level spinal realignment indicate reduced forces on the lower lumbar spine along with altered lower limb dynamics matching that of controls. Inadequate improvement in DSB may indicate increased risk of post-surgical mechanical failure. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Jeannie F Bailey
- Department of Orthopaedic Surgery, University of California, San Francisco, USA
| | - Robert P Matthew
- Department of Electrical Engineering and Computer Science, University of California, Berkeley, USA
| | - Sarah Seko
- Department of Electrical Engineering and Computer Science, University of California, Berkeley, USA
| | - Patrick Curran
- Department of Orthopaedic Surgery, University of California, San Francisco, USA
| | - Leslie Chu
- Department of Orthopaedic Surgery, University of California, San Francisco, USA
| | - Sigurd H Berven
- Department of Orthopaedic Surgery, University of California, San Francisco, USA
| | - Vedat Deviren
- Department of Orthopaedic Surgery, University of California, San Francisco, USA
| | - Shane Burch
- Department of Orthopaedic Surgery, University of California, San Francisco, USA
| | - Jeffrey C Lotz
- Department of Orthopaedic Surgery, University of California, San Francisco, USA.
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Arima H, Glassman SD, Dimar JR, Matsuyama Y, Carreon LY. Neurologic Comorbidities Predict Proximal Junctional Failure in Adult Spinal Deformity. Spine Deform 2019; 6:576-586. [PMID: 30122394 DOI: 10.1016/j.jspd.2018.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/21/2018] [Accepted: 01/27/2018] [Indexed: 10/28/2022]
Abstract
STUDY DESIGN Retrospective case-control matched cohort from a single institution. OBJECTIVE To examine the contribution of nonmechanical factors to the incidence of proximal junctional failure (PJF) after adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA Multiple studies have reported on the prevalence of PJF following surgery for ASD. However, little is known about the contribution of nonmechanical factors to the incidence of PJF. METHODS We identified a consecutive series of ASD patients who required revision surgery for PJF between 2013 and 2015. A matched cohort of ASD patients who did not develop PJF after surgical correction was identified based on age, gender, preoperative deformity type, number of fusion levels, and the lower instrumented vertebra level. We compared medical and surgical histories in the matched cohorts, with particular attention to the prevalence of preoperative neurologic comorbidities that might affect standing balance. Preoperative, immediate postoperative, and follow-up radiographs were reviewed to document specific characteristics of mechanical failure that resulted in PJF and required revision surgery. RESULTS Twenty-eight cases of PJF requiring revision surgery were identified. The prevalence rates of preoperative neurologic comorbidities in PJF cohort were significantly higher than in non-PJF cohort (75% vs. 32%, p < .001). Neurologic comorbidities included prior stroke (4), metabolic encephalopathy (2), Parkinson disease (1), seizure disorder (1), cervical and thoracic myelopathy (7), diabetic neuropathy (4), and other neuropathy (4). The mean preoperative sagittal vertical axis in PJF cohort was more positive compared with the non-PJF cohort (144 mm vs. 65 mm, p = .009) There were no significant differences in immediate postoperative or follow-up radiographic parameters between cohorts. CONCLUSIONS In this study, risk factors identified for the development of PJF included nonmechanical neurologic comorbidities, emphasizing the need to look beyond radiographic alignment in order to reduce the incidence of PJF. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Hideyuki Arima
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40204, USA; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, 1st Floor ACB, Louisville, KY 40202, USA; Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
| | - Steven D Glassman
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40204, USA; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, 1st Floor ACB, Louisville, KY 40202, USA
| | - John R Dimar
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40204, USA; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, 1st Floor ACB, Louisville, KY 40202, USA
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Leah Y Carreon
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40204, USA
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Banno T, Arima H, Hasegawa T, Yamato Y, Togawa D, Yoshida G, Yasuda T, Oe S, Mihara Y, Ushirozako H, Matsuyama Y. The Effect of Paravertebral Muscle on the Maintenance of Upright Posture in Patients With Adult Spinal Deformity. Spine Deform 2019; 7:125-131. [PMID: 30587305 DOI: 10.1016/j.jspd.2018.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 06/08/2018] [Accepted: 06/09/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We investigated the relationship between cross-sectional area (CSA) of paravertebral muscle and trunk tilt at standing and walking in adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA Although the importance of back muscles for the development of spinal kyphosis was well described, the influence on maintaining the sagittal balance was unclear. METHODS Forty-five female patients (mean age, 68.8 years) with ASD were studied. We measured sagittal vertical axis [SVA], pelvic tilt [PT], and pelvic incidence-lumbar lordosis [PI-LL]) by lateral spine radiograph. For the assessment of trunk tilt standing-trunk tilt angle (STA) by lateral standing radiograph, gait-trunk tilt angle (GTA) by lateral gait images, and the increasing trunk tilt angle (ITA) by subtracting the STA from the GTA were calculated. Using L1/2 and L4/5 axial MRI, the CSAs of bilateral multifidus muscles (MF) and elector spinae (ES) removed fat by Image J software were calculated. We examined the correlation between trunk tilt angle (STA, GTA, and ITA) and spinopelvic parameters (SVA, PT, and PI minus LL) and also the correlation among muscle CSA, trunk tilt angle (STA, GTA, and ITA), and Oswestry Disability Index (ODI). RESULTS The mean STA, GTA, and ITA were 4.2°, 13.0°, and 8.8°, respectively. The CSAs of back muscles were 278 mm2 at L1/2 MF, 1,687 mm2 at L1/2 ES, 636 mm2 at L4/5 MF, and 1,355 mm2 at L4/5 ES, respectively. Trunk tilt angle had significant relations with spinopelvic parameters. Concerning about muscle CSA, significant correlations were observed between STA and L4/5 MF (r = -0.517), GTA and L1/2 ES (r = -0.461) and L4/5 MF (r = -0.476), and ITA and L1/2 ES(r = -0.429). ODI showed significant correlation with STA and GTA. CONCLUSIONS Paravertebral muscles were crucial to keep upright posture during walking as well as standing.
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Affiliation(s)
- Tomohiro Banno
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 〒431-3192 Shizuoka Prefecture, Hamamatsu, Higashi Ward, Handayama, Japan.
| | - Hideyuki Arima
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 〒431-3192 Shizuoka Prefecture, Hamamatsu, Higashi Ward, Handayama, Japan
| | - Tomohiko Hasegawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 〒431-3192 Shizuoka Prefecture, Hamamatsu, Higashi Ward, Handayama, Japan
| | - Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 〒431-3192 Shizuoka Prefecture, Hamamatsu, Higashi Ward, Handayama, Japan
| | - Daisuke Togawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 〒431-3192 Shizuoka Prefecture, Hamamatsu, Higashi Ward, Handayama, Japan
| | - Go Yoshida
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 〒431-3192 Shizuoka Prefecture, Hamamatsu, Higashi Ward, Handayama, Japan
| | - Tatsuya Yasuda
- Department of Orthopaedic Surgery, Hamamatsu Medical Center, 328 Tomitsukacho, Naka Ward, Hamamatsu, Shizuoka Prefecture 432-8580, Japan
| | - Shin Oe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 〒431-3192 Shizuoka Prefecture, Hamamatsu, Higashi Ward, Handayama, Japan
| | - Yuki Mihara
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 〒431-3192 Shizuoka Prefecture, Hamamatsu, Higashi Ward, Handayama, Japan
| | - Hiroki Ushirozako
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 〒431-3192 Shizuoka Prefecture, Hamamatsu, Higashi Ward, Handayama, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 〒431-3192 Shizuoka Prefecture, Hamamatsu, Higashi Ward, Handayama, Japan
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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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Extensive Corrective Fixation Surgeries for Adult Spinal Deformity Improve Posture and Lower Extremity Kinematics During Gait. Spine (Phila Pa 1976) 2017; 42:1456-1463. [PMID: 28248894 DOI: 10.1097/brs.0000000000002138] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Longitudinal cohort. OBJECTIVE The present study aimed to document changes in posture and lower extremity kinematics during gait in patients with adult spinal deformity (ASD) after extensive corrective surgery. SUMMARY OF BACKGROUND DATA Standing radiographic parameters are typically used to evaluate patients with ASD. Previously, preoperative walking and standing posture discrepancy were reported in patients with ASD. We did not include comparison between before and after surgery. Therefore, we thought that pre- and postoperative evaluations for patients with ASD should include gait analysis. METHODS Thirty-nine patients with ASD (5 men, 34 women; mean age, 71.0 ± 6.1) who underwent posterior corrective fixation surgeries from the thoracic spine to the pelvis were included. A 4-m walk was recorded and analyzed. Sagittal balance while walking was calculated as the angle between the plumb line on the side and the line connecting the greater trochanter and pinna while walking (i.e., the gait-trunk tilt angle [GTA]). We measured maximum knee extension angle during one gait cycle, step length (cm), and walking speed (m/min). Radiographic parameters were also measured. RESULTS The mean GTA and the mean maximum knee extension angle significantly improved from 13.4° to 6.4°, and -13.3° to -9.4°(P < 0.001 and P = 0.006), respectively. The mean step length improved from 40.4 to 43.1 cm (P = 0.049), but there was no significant change in walking speed (38.4 to 41.5 m/min, P = 0.105). Postoperative GTA, maximum knee extension angle and step length correlated with postoperative pelvic incidence minus lumbar lordosis (r = 0.324, P = 0.044; r = -0.317, P = 0.049; r = -0.416, P = 0.008, respectively). CONCLUSION Our results suggest that postoperative posture, maximum knee extension angle, and step length during gait in patients with ASD improved corresponding to how much correction of the sagittal spinal deformity was achieved. LEVEL OF EVIDENCE 3.
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