Analysis of Relationships between Spinal Deformity and Walking Ability in Parkinson's Disease Patients

Abstract

Introduction This study aimed to determine impacts on walking ability of spinal deformity and imbalance as distinct from movement disorders in Parkinson's disease (PD). Methods Thirty-two patients (15 males, 17 females; mean age 72.5 years) were analyzed. Three, thirteen, eleven, and five were at Hoehn-Yahr stages I, II, III, and IV, respectively. In addition to various spinal imbalance and deformity classifications the following were assessed: Cobb angle (CA) for scoliosis, thoracic kyphosis (TK) at T2-12, thoracolumbar kyphosis(TLK) at T12-L2, lumbar lordosis(LL) at L1-S1, pelvic tilt(PT), pelvic incidence(PI), and sagittal vertical axis(SVA). The Timed Up and Go (TUG) test was used to measure walking ability. Patients were evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS) part III, and bone mineral density (BMD) scans. Results Nineteen patients (59%) had spinal deformity and imbalance within the following classifications: thoracic scoliosis, 1; thoracic kyphosis, 2; lumbar scoliosis, 15; Pisa syndrome, 3; camptocormia, 2. Mean values were 20.0° CA for scoliosis, 42.3° TK, 14.8° TLK, 26.7° LL, 20.8° PT, 48.8° PI, and 66.4 mm SVA. The mean TUG score was 13.9s. The UPDRS III mean was 36.6±24.5 points. Mean BMD was 0.856 g/cm2 at lumbar L2-4 and 0.585 g/cm2 at the femoral neck. UPDRS part III (P<0.001), LL (P<0.05), and femoral neck BMD (P<0.05) significantly correlated to TUG test results. Conclusions Distinct from the movement disorders of PD (UPDRS III), loss of normal LL and loss of BMD at the femoral neck were shown to be correlated with diminished walking ability (TUG test) in PD patients. When UPDRS improved in response to L-dopa, walking ability improved. In addition to any PD-specific interventions that contribute to the maintenance of ambulation, interventions specific to the restoration of LL, as well as early treatment for osteoporosis may positively affect HRQOL in PD.

Relationship between Lower Limbs Performance and Spinal Alignment in Parkinson’s Disease Patients: An Observational Study with Cross Sectional Design

“…These correlations explain how the loss of lumbar lordosis in PD is accompanied by lower limb functionality impairment, and this recalls what has been described by Nakamura et al in a recent study, where the authors demonstrated how the LL value correlates to the timed up-and-go test performance [22]. The absence of a correlation between the lower-extremity strength and the spinal alignment parameters in the control group, not affected by neurodegenerative disease, demonstrates that PD patients are affected by a specific maladaptive process that involves spinal alignment and lower limbs through the lumbopelvic unit.…”

The Effects of Heel Lifts on Dynamic Measures of Gait and Static Posture in Individuals with Parkinson’s disease

“…As a result, energy consumption during activity is increased; compromising a person's ability to maintain balance when walking or standing. 9 This is consistent with our concept of improving upright alignment and moving the COM more directly over the feet to improve stability.…”

“…In doing so, it is possible that heel lifts improve balance confidence with turning during walking by increasing visual input into the system. Lastly, Nakamura et al (2019) found that a loss of lumbar lordosis negatively affects TUG time in patients with PD and theorizes this may be due to one's center of gravity falling outside their base of support when the natural curve of the spine is lost with a stooped posture. As a result, energy consumption during activity is increased; compromising a person's ability to maintain balance when walking or standing.…”

“…These studies agree that by establishing a normal alignment of the tibia, the body's center of mass (COM) is able to shift back over its base of support creating a greater sense of balance and stability. [7][8][9] There are many challenges related to balance and motor activity in walking that the individual with PD must face, therefore, if a simple intervention addressing the pathobiomechanics of alignment can improve perceived stability, it is worth investigating if this intervention also has a positive impact on gait. The purpose of this study was to expand upon the Hastings et al ( 2018) study by repeating their work on static postural alignment and further exploring whether the use of heel lifts provides improvements in the dynamic gait parameters of step length, gait speed, Timed Up and Go (TUG) scores, and balance confidence as compared to when they are not used in individuals with PD.…”

Deep brain stimulation in the subthalamic nuclei alters postural alignment and adaptation in Parkinson’s disease

“…One reason for this is that dysfunction of the basal ganglia in PD can lead to alterations of resting body position, muscle tone and inhibition of the latissimus dorsi muscles [ 1 ]. The resulting trunk flexion, which is an anterior leaning of the trunk towards the hip during standing [ 2 ], increases postural instability and alters walking ability [ 3 ]. Medical intervention includes botulinum toxin injections into axial muscles, which is only partially effective.…”