Alterations of gait kinematics depend on the deformity type in the setting of adult spinal deformity,European Spine Journal

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Alterations of gait kinematics depend on the deformity type in the setting of adult spinal deformity
European Spine Journal ( IF 2.6 ) Pub Date : 2022-08-27 , DOI: 10.1007/s00586-022-07348-y
Karl Semaan ₁ , Rami Rachkidi ₁ , Eddy Saad ₁ , Abir Massaad ₁ , Georges Kawkabani ₁ , Renée Maria Saliby ₁ , Mario Mekhael ₁ , Krystel Abi Karam ₁ , Marc Fakhoury ₁ , Elena Jaber ₁ , Ismat Ghanem ₁ , Wafa Skalli ₂ , Virginie Lafage ₃ , Ayman Assi _{1,

2}

Affiliation

Purpose

To evaluate 3D kinematic alterations during gait in Adult Spinal Deformity (ASD) subjects with different deformity presentations.

Methods

One hundred nineteen primary ASD (51 ± 19y, 90F), age and sex-matched to 60 controls, underwent 3D gait analysis with subsequent calculation of 3D lower limb, trunk and segmental spine kinematics as well as the gait deviation index (GDI). ASD were classified into three groups: 51 with sagittal malalignment (ASD-Sag: SVA > 50 mm, PT > 25°, and/or PI-LL > 10°), 28 with only frontal deformity (ASD-Front: Cobb > 20°) and 40 with only hyperkyphosis (ASD-HyperTK: TK > 60°). Kinematics were compared between groups.

Results

ASD-Sag had a decreased pelvic mobility compared to controls with a decreased ROM of hips (38 vs. 45°) and knees (51 vs. 61°). Furthermore, ASD-Sag exhibited a decreased walking speed (0.8 vs. 1.2 m/s) and GDI (80 vs. 95, all p < 0.05) making them more prone to falls. ASD-HyperTK showed similar patterns but in a less pronounced way. ASD-Front had normal walking patterns. GDI, knee flex/extension and walking speed were significantly associated with SVA and PT (r = 0.30–0.65).

Conclusion

Sagittal spinal malalignment seems to be the driver of gait alterations in ASD. Patients with higher GT, SVA, PT or PI-LL tended to walk slower, with shorter steps in order to maintain stability with a limited flexibility in the pelvis, hips and knees. These changes were found to a lesser extent in ASD with only hyperkyphosis but not in those with only frontal deformity. 3D gait analysis is an objective tool to evaluate functionality in ASD patients depending on their type of spinal deformity.

Level of evidence I

Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

中文翻译：

步态运动学的改变取决于成人脊柱畸形情况下的畸形类型

目的

评估具有不同畸形表现的成人脊柱畸形 (ASD) 受试者步态期间的 3D 运动学改变。

方法

119 名原发性 ASD（51 ± 19 岁，90F），年龄和性别与 60 名对照者匹配，接受 3D 步态分析，随后计算 3D 下肢、躯干和节段脊柱运动学以及步态偏差指数 (GDI)。ASD 被分为三组：51 人有矢状面排列不齐（ASD-Sag：SVA > 50 mm，PT > 25°，和/或 PI-LL > 10°），28 人只有额部畸形（ASD-Front：Cobb > 20 °) 和 40 只伴有后凸过度 (ASD-HyperTK: TK > 60°)。比较各组之间的运动学。

结果

与对照组相比，ASD-Sag 的骨盆活动度降低，髋关节活动度降低（38 对 45°）和膝关节活动度（51 对 61°）。此外，ASD-Sag 表现出行走速度（0.8 对 1.2 m/s）和 GDI（80 对 95，所有p < 0.05）的降低，使他们更容易跌倒。ASD-HyperTK 显示出类似的模式，但不太明显。ASD-Front 有正常的行走模式。GDI、膝盖弯曲/伸展和步行速度与 SVA 和 PT 显着相关 ( r = 0.30–0.65)。

结论

矢状脊柱错位似乎是 ASD 步态改变的驱动因素。具有较高 GT、SVA、PT 或 PI-LL 的患者往往走得较慢，步幅较短，以保持稳定，但骨盆、臀部和膝盖的柔韧性有限。这些变化在仅伴有后凸过度的自闭症谱系障碍中发现的程度较小，但在仅伴有额叶畸形的自闭症谱系障碍中未发现。3D 步态分析是根据脊柱畸形类型评估 ASD 患者功能的客观工具。