Thoracic kyphosis and pelvic anteversion in patients with adult spinal deformity increase while walking: analyses of dynamic alignment change using a three-dimensional gait motion analysis system

Miura, Kousei; Kadone, Hideki; Koda, Masao; Abe, Tetsuya; Funayama, Toru; Noguchi, Hiroshi; Mataki, Kentaro; Nagashima, Katsuya; Kumagai, Hiroshi; Shibao, Yosuke; Suzuki, Kenji; Yamazaki, Masashi

doi:10.1007/s00586-020-06312-y

Cited by 25 publications

(43 citation statements)

References 21 publications

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“…Static sagittal spino-pelvic parameters measured by full-spine lateral standing radiographs are influenced by transient compensations for spinal deformity and may underestimate spinal balance 5 . As previously reported, 3D gait analysis demonstrated that spinal kyphosis and pelvic anteversion significantly increased while walking and detected a failure of compensation for ASD 6 . Although 3D gait analysis could be optimal for quantitatively evaluating spinal balance, it has a high initial cost, making its broad use difficult.…”

Section: Discussionsupporting

confidence: 78%

“…To resolve issues related to static evaluations, three-dimensional (3D) gait analysis using motion capture systems for ASD patients have been used recently to evaluate dynamic spino-pelvic balance. A few clinical studies using gait motion analysis have reported that dynamic sagittal spino-pelvic balance deteriorated during walking in patients who have thoracolumbar spinal deformity 5 , 6 , indicating that dynamic evaluation of spinal sagittal balance may be an important addition to conventional full-spine lateral standing radiographs. However, it is difficult to perform 3D gait analysis as it requires special, and not always available, instrumentation.…”

Section: Introductionmentioning

confidence: 99%

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The fatty degeneration of the lumbar erector spinae muscles affects dynamic spinal compensation ability during gait in adult spinal deformity

Miura

Kadone

Asada

et al. 2021

Sci Rep

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This study aimed to investigate whether fat infiltration in lumbar paravertebral muscles assessed by magnetic resonance imaging (MRI) could be related to dynamic sagittal spino-pelvic balance during gait in adult spinal deformity (ASD). This is a retrospective analysis of 28 patients with ASD. The fat infiltration rate of lumbar erector spinae muscles, multifidus muscles and psoas major muscles was measured by T2 weighted axial MRI at L1-2 and L4-5. Dynamic sagittal spinal and pelvic angles during gait were evaluated using 3D motion analysis. The correlation between fat infiltration rate of those muscles with variations in dynamic kinematic variables while walking and static radiological parameters was analyzed. Spinal kyphosis and pelvic anteversion significantly increased during gait. Fat infiltration rate of erector spinae muscles at L1-2 was positively correlated with thoracic kyphosis (r = 0.392, p = 0.039) and pelvic tilt (r = 0.415, p = 0.028). Increase of spinal kyphosis during walking was positively correlated with fat infiltration rate of erector spinae muscles both at L1-2 (r = 0.394, p = 0.038) and L4-5 (r = 0.428, p = 0.023). Qualitative evaluation of lumbar erector spinae muscles assessed by fat infiltration rate has the potential to reflect dynamic spino-pelvic balance during gait.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

The fatty degeneration of the lumbar erector spinae muscles affects dynamic spinal compensation ability during gait in adult spinal deformity

Miura

Kadone

Asada

et al. 2021

Sci Rep

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“…T-SA is the angle between the gravity line and the thoracic spine and P-SA is the angle between the pelvis and the horizontal line, both of which could be compensated by pelvic retroversion and knee-exion respectively. SVA is one of the most widely known parameters indicating the severity of deformity and is exacerbated while walking 17 , but could also be directly in uenced by compensation from pelvic retroversion and knee exion. By contrast, T-PSA, which is de ned as the angle between the thoracic spine and the pelvis, could subtract the effect of pelvic retroversion and was independent of knee exion.…”

Section: Discussionmentioning

confidence: 99%

“…Our analysis required that patients walk for as long as possible to establish their fatigue status, and we averaged the parameters from only the nal lap. The advantages of each study are unclear, but spinal alignment was different when the rst lap and the nal lap were compared 17 . The patient fatigue status and spinal alignment at that time should be interpreted carefully.…”

Section: Discussionmentioning

confidence: 99%

Can Proximal Junctional Kyphosis After Surgery for Adult Spinal Deformity Be Predicted by Preoperative Dynamic Sagittal Alignment Change With 3D Gait Analysis? A Case–control Study

Asada

Miura

Koda

et al. 2021

Preprint

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PurposeTo investigate whether preoperative dynamic spinal alignment that worsened during gait as detected by three-dimensional (3D) gait analysis can be a predictive factor for proximal junctional kyphosis (PJK) after corrective surgery for adult spinal deformity (ASD) with a minimum 1-year follow-up.MethodWe included 27 patients with ASD who underwent 3D gait analysis before corrective surgery and had >1-year follow-up. Dynamic spinal alignment parameters were obtained using a Nexus motion capture system (Vicon, Oxford, UK) with reflective markers. Spinal alignment was assessed in each region and pelvic alignment was assessed with surface markers. Patients were asked to walk for as long as possible around an oval walkway. We obtained the averaged dynamic parameters in the final lap and compared them between patients with PJK(+) and those with PJK(–).ResultsPJK occurred in 7 patients (26%). Preoperative angle between the thoracic spine and the pelvis was larger in patients with PJK(+) than in those with PJK(–) (32.3 ± 8.1 vs 18.7 ± 13.5, P = 0.020) with sufficient sample size. Multiple logistic regression analysis identified the angle between the thoracic spine and pelvis as an independent risk for PJK.ConclusionPreoperative thoracic kyphosis exacerbated by gait as determined in 3D gait analysis is a preoperative independent risk factor of PJK in patients undergoing ASD corrective surgery.

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“…Lasting effect after the HAL intervention period was evaluated by comparing cervical alignment during gait before the first session (PRE) and after the last session (POST). Gait of PRE and POST was assessed by a long-time walking protocol for evaluation of postural balance during gait [19][20][21], where the patient was asked to keep walking as long as possible at a comfortable pace on a flat ground surface repeating 10 m straight walk and semi-circular turning until perception of fatigue or pain. The long-time walking protocol was adopted, because the spinal alignment during gait is considered more directly related to ADLs than that in static standing posture [19][20][21].…”

Section: Assessment Of Cervical Alignment During Gaitmentioning

confidence: 99%

Dropped Head Syndrome Attenuation by Hybrid Assistive Limb: A Preliminary Study of Three Cases on Cervical Alignment during Walking

et al. 2020

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Background and Objectives: Dropped head syndrome (DHS) is characterized by apparent neck extensor muscle weakness and difficulty in extending the neck to raise the head against gravity. DHS affects forward vision and eating behavior, and hence impairs quality of life. However, standardized treatment of DHS has not yet been established. The purpose of this preliminary study is to seek for a possibility of effective non-surgical, conservative treatment for DHS, by applying a robotic treatment. Materials and Methods: A wearable exoskeleton type robot suit hybrid assistive limb (HAL) was applied to three patients with DHS. A course of HAL treatment included 10 sessions of gait training using HAL. One session lasted about an hour. Case 1 completed the course twice, the first time in two weeks (one session per day) and second time in 10 months (one session per month). Case 2 and Case 3 completed the course once in 10 weeks (one session per week) and in 6 months (one session per 2.5 weeks), respectively. Immediate and lasting effects of HAL on the reduction of cervical sagittal vertical alignment (SVA) during gait was evaluated using a motion capture system. Results: Case 1 showed improvement of cervical alignment during gait after the HAL courses of both different frequencies. Case 2 did not show improvement of cervical alignment during gait. Case 3 showed improvement of cervical kyphosis but not of cervical sagittal alignment during gait. Conclusions: The results of the preliminary study suggest that gait training using HAL may be an effective option of conservative treatment for a part of DHS patients. They also suggest that a lack of immediate effects on the cervical alignment and a lack of ability to perform compensatory trunk motion may indicate a non-responding patient. Generalization of the results requires further research with more cases.

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Thoracic kyphosis and pelvic anteversion in patients with adult spinal deformity increase while walking: analyses of dynamic alignment change using a three-dimensional gait motion analysis system

Cited by 25 publications

References 21 publications

The fatty degeneration of the lumbar erector spinae muscles affects dynamic spinal compensation ability during gait in adult spinal deformity

The fatty degeneration of the lumbar erector spinae muscles affects dynamic spinal compensation ability during gait in adult spinal deformity

Can Proximal Junctional Kyphosis After Surgery for Adult Spinal Deformity Be Predicted by Preoperative Dynamic Sagittal Alignment Change With 3D Gait Analysis? A Case–control Study

Dropped Head Syndrome Attenuation by Hybrid Assistive Limb: A Preliminary Study of Three Cases on Cervical Alignment during Walking

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