Effect of Surgical Fusion on Volitional Weight-Shifting in Individuals With Adolescent Idiopathic Scoliosis

Abstract

Study Design: Prospective. Objectives: The goals of this study were to (1) evaluate the differences in weightbearing symmetry between individuals with adolescent idiopathic scoliosis (AIS) and typically developing controls; (2) observe the effect of posterior spinal fusion and instrumentation (PSFI) on volitional weight-shifting at 1 and 2 years postoperatively; and (3) evaluate whether lowest instrumented fusion level (ie, lowest instrumented vertebra [LIV]) in PSFI has an effect on volitional weight-shifting.NOT THE PUBLISHED VERSION; this is the author's final, peer-reviewed manuscript. The published version may be accessed by following the link in the citation at the bottom of the page.Spine Deformity, Vol 4, No. 6 (November 2016): pg. 432-438. DOI. This article is © Elsevier and permission has been granted for this version to appear in e-Publications@Marquette. Elsevier does not grant permission for this article to be further copied/distributed or hosted elsewhere without the express permission from Elsevier. 3Summary of Background Data: Previous studies have conflicting findings with regard to the effect of scoliosis on postural control tasks as well as the effect of surgery. They have also noted an inconsistent effect of PSFI at different LIVs, with more distal LIVs exhibiting greater reductions in postoperative range of motion. Methods: The study was designed with an AIS group of 41 patients (8 males and 33 females) with AIS who underwent PSFI, along with a Control Group of 24 age-matched typically developing participants (12 male and 12 female). Both groups performed postural control tasks (static balance and volitional weight-shifting), with the AIS group repeating the tasks at 1 and 2 years postoperatively. Results: At baseline, the AIS group showed increased weightbearing asymmetry than the Control Group (p = .01). The AIS group showed improvements in volitional weight-shifting at 2 years over baseline (p < .01). There was no effect of LIV on volitional weight-shifting by the second postoperative year. Conclusions: Individuals with AIS have greater weightbearing asymmetry but improved volitional weight-shifting over typically developing controls. PSFI improves volitional weight-shifting beyond preoperative baseline but does not differ significantly by LIV.

Adolescent idiopathic scoliosis: evaluating perioperative back pain through a simultaneous morphological and biomechanical approach

“…Schimmel et al [ 11 ] have found that postural balance parameters 1 year after surgery did not differ from preoperative results. Similar results were obtained by other authors studying AIS [ 12 , 13 ] and adults with spinal deformity [ 14 ]. However, since the reported literature is scarce and investigators have used different methodological approaches [ 10 – 15 ], it is difficult to draw a definitive conclusion on the subject.…”

Effects of Spinal Fusion for Idiopathic Scoliosis on Lower Body Kinematics During Gait*

“…This work also showed patients with AIS to have poorer postural stability when compared to normal subjects [21]. This contradicts the work of Kurapati et al [15], which showed patients with AIS to have improved volitional weight shifting over typically developing controls, suggesting they learn to improve the initial accuracy of their weight shifts despite an aberrant center of gravity.…”

“…The concept of "saving a level" by stopping the fusion short must be weighed against the potential to leave an undercorrected or unbalanced spine [14]. Although several publications have described the contribution of LIV to trunk mobility [5] and volitional weight shifting [15], no studies have compared gait outcomes between varying LIV.…”

The impact of spinal fusion of adolescent idiopathic scoliosis in Salah (Islamic Prayer) movement: a case-control study

“…30 Many studies about the lumbar stiffness as the side effect of the spinal fusion in AIS have reported that the frontal plane of thorax-pelvis mobility improved, the volitional weight shifting that gave them postural control also improved, and the SRS score did not correlate with the outcome motion of the fused level. [31][32][33] However, these phenomena could not be covered by SRS-30 and its variants. The evaluation of scoliosis treatment comprises the surgical aspects, radiology aspects, and the most important is the quality of life (function, pain, and deformity).…”