Gait kinematic alterations in subjects with adult spinal deformity and their radiological determinants

Abstract

Background: Adults with spinal deformity (ASD) are known to have postural malalignment affecting their quality of life. Classical evaluation and follow-up are usually based on full-body static radiographs and health related quality of life questionnaires. Despite being an essential daily life activity, formal gait assessment lacks in clinical practice.Research Question: What are the main alterations in gait kinematics of ASD and their radiological determinants? Methods: 52 ASD and 63 control subjects underwent full-body 3D gait analysis with calculation of joint kinematics and full-body biplanar X-rays with calculation of 3D postural parameters. Kinematics and postural parameters were compared between groups. Determinants of gait alterations among postural radiographic parameters were explored. Results: ASD had increased sagittal vertical axis (SVA:34 ± 59 vs − 5 ± 20 mm), pelvic tilt (PT:19 ± 13 vs 11 ± 6 • ) and frontal Cobb (25 ± 21 vs 4 ± 6 • ) compared to controls (all p < 0.001). ASD displayed decrease walking speed (0.9 ± 0.3 vs 1.2 ± 0.2 m/s), step length (0.58 ± 0.11 vs 0.64 ± 0.07 m) and increased single support (0.45 ± 0.05 vs 0.42 ± 0.04 s). ASD walked with decreased hip extension in stance (− 3 ± 10 vs − 7 ± 8 • ), increased knee flexion at initial contact and in stance (10 ± 11 vs 5 ± 10 • and 19 ± 7 vs 16 ± 8 • respectively), and decreased knee flexion/extension ROM (55 ± 9 vs 59 ± 7 • ). ASD had increased trunk flexion (12 ± 12 vs 6 ± 11 • ) and reduced dynamic lumbar lordosis (− 11 ± 12 vs − 15 ± 7 • , all p < 0.001). Sagittal knee ROM, walking speed and step length were negatively determined by SVA; lack of lumbar lordosis during gait was negatively determined by radiological lumbar lordosis. Significance: Static compensations in ASD persist during gait, where they exhibit a flexed attitude at the trunk, hips and knees, reduced hip and knee mobility and loss of dynamic lordosis. ASD walked at a slower pace with increased single and double support times that might contribute to their gait stability. These dynamic discrepancies were strongly related to static sagittal malalignment.

Alteration of the Sitting and Standing Movement in Adult Spinal Deformity

“…Patients with adult spinal deformity (ASD) are known to have quality of life (HRQOL) alterations and functional limitations ( Pellisé et al, 2015 ; Christopher Kieser and Wyatt, 2019 ). While gait adaptations in ASD have been previously described in the literature ( Kawkabani et al, 2021 ), alterations in other daily life activities, such as sitting and standing, have been poorly characterized. Furthermore, ASD represent a complex and heterogeneous entity differing in radiographic alterations, HRQOL scores, and even outcome after surgical intervention ( Bess et al, 2016 ; Bakhsheshian et al, 2017 ; Yang et al, 2019 ).…”

“…As mentioned earlier, in the static standing position, knee flexion acts as a compensation mechanism that repositions the center of gravity above the feet. The same mechanism is also maintained during walking, therefore limiting knee extension and leading to decreased knee ROM during gait and eventually decreased step length ( Kawkabani et al, 2021 ; Severijns et al, 2021 ). However, in the static sitting position, the height of the seat was adjusted so that all individuals had the same initial knee flexion of 90°.…”

“…Overall, both ASD-sag and ASD-hyperTK maintained a flexed trunk during sit-to-stand and stand-to-sit. This forward inclination of the trunk is a characteristic feature of ASD in the standing position and has been shown to persist during gait in ASD individuals ( Kawkabani et al, 2021 ). Furthermore, this was also described in other studies where peak dynamic SVA during sit-to-stand was shown to be increased in ASD ( Bailey et al, 2019 ).…”

“…Motion analysis is increasingly being used to assess functionality in ASD subjects. Kawkabani et al have shown that ASD subjects walked slower with an increased double support phase, and maintained a flexed attitude in their thorax, hips, and knees while walking ( Kawkabani et al, 2021 ). Severijns et al also described a similar finding in ASD subjects with a decompensated sagittal deformity ( Severijns et al, 2021 ).…”

Factors Related to Preoperative Coronal Malalignment in Degenerative Lumbar Scoliosis: An Analysis on Coronal Parameters

“…It is well‐known that sagittal imbalance has undermined the quality of life (QoL) significantly in patients with degenerative lumbar scoliosis (DLS), however, there is no consistent conclusion about the effects of coronal malalignment (CM) that had on the QoL in those patients 1 , 2 , 3 . CM may cause severe gait disturbance, less satisfaction, and low back pain 4 , 5 . According to the spinal surgeon's experience, patients with adult scoliosis would have the severe reduction in QoL even with moderate grades of CM, which may be more serious in those coinciding with sagittal imbalance.…”