Guillaume Rebeyrat1, Wafa Skalli1, Rami Rachkidi2, Hélène Pillet1, Abir Massaad2, Joe Mehanna2, Karl Semaan2, Eddy Saad2, Ismat Ghanem2, Ayman Assi3,4. 1. Institut de Biomécanique Humaine Georges Charpak, Arts Et Métiers Institute of Technology, Paris, France. 2. Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon. 3. Institut de Biomécanique Humaine Georges Charpak, Arts Et Métiers Institute of Technology, Paris, France. ayman.assi@usj.edu.lb. 4. Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon. ayman.assi@usj.edu.lb.
Abstract
PURPOSE: To assess dynamic postural alignment in ASD during walking using a subject-specific 3D approach. METHODS: 69 ASD (51 ± 20 years, 77%F) and 62 controls (34 ± 13 years, 62%F) underwent gait analysis along with full-body biplanar Xrays and filled HRQoL questionnaires. Spinopelvic and postural parameters were computed from 3D skeletal reconstructions, including radiographic odontoid to hip axis angle (ODHA) that evaluates the head's position over the pelvis (rODHA), in addition to rSVA and rPT. The 3D bones were then registered on each gait frame to compute the dynamic ODHA (dODHA), dSVA, and dPT. Patients with high dODHA (> mean + 1SD in controls) were classified as ASD-DU (dynamically unbalanced), otherwise as ASD-DB (dynamically balanced). Between-group comparisons and relationship between parameters were investigated. RESULTS: 26 patients were classified as ASD-DU having an average dODHA of 10.4° (ASD-DB: 1.2°, controls: 1.7°), dSVA of 112 mm (ASD-DB: 57 mm, controls: 43 mm), and dPT of 21° (ASD-DB: 18°, controls: 14°; all p < 0.001). On static radiographs, ASD-DU group showed more severe sagittal malalignment than ASD-DB, with more altered HRQoL outcomes. The ASD-DU group had an overall abnormal walking compared to ASD-DB & controls (gait deviation index: 81 versus 93 & 97 resp., p < 0.001) showing a reduced flexion/extension range of motion at the hips and knees with a slower gait speed and shorter step length. Dynamic ODHA was correlated to HRQoL scores. CONCLUSION: Dynamically unbalanced ASD had postural malalignment that persist during walking, associated with kinematic alterations in the trunk, pelvis, and lower limbs, making them more prone to falls. Dynamic-ODHA correlates better with HRQoL outcomes than dSVA and dPT.
PURPOSE: To assess dynamic postural alignment in ASD during walking using a subject-specific 3D approach. METHODS: 69 ASD (51 ± 20 years, 77%F) and 62 controls (34 ± 13 years, 62%F) underwent gait analysis along with full-body biplanar Xrays and filled HRQoL questionnaires. Spinopelvic and postural parameters were computed from 3D skeletal reconstructions, including radiographic odontoid to hip axis angle (ODHA) that evaluates the head's position over the pelvis (rODHA), in addition to rSVA and rPT. The 3D bones were then registered on each gait frame to compute the dynamic ODHA (dODHA), dSVA, and dPT. Patients with high dODHA (> mean + 1SD in controls) were classified as ASD-DU (dynamically unbalanced), otherwise as ASD-DB (dynamically balanced). Between-group comparisons and relationship between parameters were investigated. RESULTS: 26 patients were classified as ASD-DU having an average dODHA of 10.4° (ASD-DB: 1.2°, controls: 1.7°), dSVA of 112 mm (ASD-DB: 57 mm, controls: 43 mm), and dPT of 21° (ASD-DB: 18°, controls: 14°; all p < 0.001). On static radiographs, ASD-DU group showed more severe sagittal malalignment than ASD-DB, with more altered HRQoL outcomes. The ASD-DU group had an overall abnormal walking compared to ASD-DB & controls (gait deviation index: 81 versus 93 & 97 resp., p < 0.001) showing a reduced flexion/extension range of motion at the hips and knees with a slower gait speed and shorter step length. Dynamic ODHA was correlated to HRQoL scores. CONCLUSION: Dynamically unbalanced ASD had postural malalignment that persist during walking, associated with kinematic alterations in the trunk, pelvis, and lower limbs, making them more prone to falls. Dynamic-ODHA correlates better with HRQoL outcomes than dSVA and dPT.
Authors: Justin K Scheer; Darryl Lau; Justin S Smith; Sang-Hun Lee; Michael M Safaee; Marissa Fury; Christopher P Ames Journal: Neurosurgery Date: 2021-03-15 Impact factor: 4.654
Authors: Bassel G Diebo; Neil V Shah; Oheneba Boachie-Adjei; Feng Zhu; Dominique A Rothenfluh; Carl B Paulino; Frank J Schwab; Virginie Lafage Journal: Lancet Date: 2019-07-11 Impact factor: 79.321
Authors: Justin S Smith; Christopher I Shaffrey; Virginie Lafage; Benjamin Blondel; Frank Schwab; Richard Hostin; Robert Hart; Brian O'Shaughnessy; Shay Bess; Serena S Hu; Vedat Deviren; Christopher P Ames Journal: J Neurosurg Spine Date: 2012-08-03