Ram Haddas1, Xiaobang Hu2, Isador H Lieberman2. 1. Texas Back Institute. 2. Scoliosis and Spine Tumor Center, Texas Back Institute, Texas Health Presbyterian Hospital, Plano, TX.
Abstract
STUDY DESIGN: A prospective cohort study. OBJECTIVE: The objective of this study was to establish the correlation between radiographic spinopelvic parameters with objective biomechanical measures of function in patients with adult degenerative scoliosis (ADS). SUMMARY OF BACKGROUND DATA: Gait and balance analyses can provide an objective measure of function. Patients with ADS demonstrate altered gait and balance patterns. Spinopelvic parameters are commonly used by clinicians to evaluate patients with ADS. However, to the best of our knowledge, no studies have examined the correlation between patients' radiographic spinopelvic parameters and biomechanical gait and balance parameters. PATIENT SAMPLE: Forty-four patients with symptomatic ADS who have been deemed, appropriate surgical candidates. METHODS: Radiographic spinopelvic parameters (CVA: central vertical axis, SVA: sagittal vertical axis, Cobb angle, PI-LL mismatch: pelvic incidence lumbar lordosis mismatch, and T1PA: T1 pelvic angle) were obtained the week before surgery. Then, gait and functional balance analyses (spatiotemporal parameters, center of mass, and head sway parameters) were performed on the same day. Correlations were determined between the radiographic spinopelvic parameters and biomechanical gait and balance parameters using Pearson product correlation. RESULTS: Our results show that patients with higher Cobb angle and CVA tend to walk slower (r=-0.494, P<0.05). Furthermore, the higher the Cobb angle (r=0.396), CVA (r=0.412), SVA (r=0.440), and PI-LL mismatch (r=0.493), the more time ADS patients spend with their feet planted during single and double support phases of gait (P<0.05). In addition, patients with a higher Cobb angle, CVA, SVA, PI-LL mismatch, and T1PA, exhibited more trunk sway, increased lower extremity neuromuscular activity, and decreased spine neuromuscular activity (0.331<r<0.716, P<0.05). CONCLUSIONS: This study demonstrated a moderate correlation between the biomechanical parameters as measured with gait and balance analyses and the radiographic spinopelvic parameters in ADS patients. With higher pathologic spinopelvic parameters, single support time, center of mass, and head sway and lower extremity neuromuscular activity were all increased. Quantified gait and balance analyses can be a useful tool to evaluate patient outcomes. Objective functional performance measures can help to improve the evaluation and understanding of the biomechanical effects of spinal disorders on locomotion.
STUDY DESIGN: A prospective cohort study. OBJECTIVE: The objective of this study was to establish the correlation between radiographic spinopelvic parameters with objective biomechanical measures of function in patients with adult degenerative scoliosis (ADS). SUMMARY OF BACKGROUND DATA: Gait and balance analyses can provide an objective measure of function. Patients with ADS demonstrate altered gait and balance patterns. Spinopelvic parameters are commonly used by clinicians to evaluate patients with ADS. However, to the best of our knowledge, no studies have examined the correlation between patients' radiographic spinopelvic parameters and biomechanical gait and balance parameters. PATIENT SAMPLE: Forty-four patients with symptomatic ADS who have been deemed, appropriate surgical candidates. METHODS: Radiographic spinopelvic parameters (CVA: central vertical axis, SVA: sagittal vertical axis, Cobb angle, PI-LL mismatch: pelvic incidence lumbar lordosis mismatch, and T1PA: T1 pelvic angle) were obtained the week before surgery. Then, gait and functional balance analyses (spatiotemporal parameters, center of mass, and head sway parameters) were performed on the same day. Correlations were determined between the radiographic spinopelvic parameters and biomechanical gait and balance parameters using Pearson product correlation. RESULTS: Our results show that patients with higher Cobb angle and CVA tend to walk slower (r=-0.494, P<0.05). Furthermore, the higher the Cobb angle (r=0.396), CVA (r=0.412), SVA (r=0.440), and PI-LL mismatch (r=0.493), the more time ADSpatients spend with their feet planted during single and double support phases of gait (P<0.05). In addition, patients with a higher Cobb angle, CVA, SVA, PI-LL mismatch, and T1PA, exhibited more trunk sway, increased lower extremity neuromuscular activity, and decreased spine neuromuscular activity (0.331<r<0.716, P<0.05). CONCLUSIONS: This study demonstrated a moderate correlation between the biomechanical parameters as measured with gait and balance analyses and the radiographic spinopelvic parameters in ADSpatients. With higher pathologic spinopelvic parameters, single support time, center of mass, and head sway and lower extremity neuromuscular activity were all increased. Quantified gait and balance analyses can be a useful tool to evaluate patient outcomes. Objective functional performance measures can help to improve the evaluation and understanding of the biomechanical effects of spinal disorders on locomotion.