CORRELATION BETWEEN PHYSICAL FUNCTION, RADIOGRAPHIC SAGITTAL ALIGNMENT, AND DISCREPANCY BETWEEN STANDING AND WALKING POSTURE IN PATIENTS WITH ADULT SPINAL DEFORMITY

Y. Saimon¹, A.-C. Goh¹, K. Momose², D. Ryuuzaki³, H. Akahane³, K. Mukaiyama⁴

¹Iryo Sosei University, Department of Physical Therapy, Iwaki, Japan, ²Shinshu University, Department of Physical Therapy, Matsumoto, Japan, ³North Alps Medical Center Azumi Hospital, Department of Rehabilitation, Ikeda, Japan, ⁴North Alps Medical Center Azumi Hospital, Department of Orthopedic Surgery, Ikeda, Japan

Background: Patients with adult spinal deformity who have sagittal imbalance generally have gait disturbance and walk with a greater forward tilt of the trunk as compared to that when standing. However, the physical functions and standing sagittal alignment associated with discrepancy in the trunk forward tilt between standing and gait in patients with adult spinal deformity are not clear.

Purpose: The aims of this study were to examine the relationship between discrepancy in the trunk inclination angle (TIA) during standing and walking regarding their
1) range of motion/muscle strength of the spine and lower limbs and
2) radiographic sagittal alignment in patients with adult spinal deformities to adequately target the appropriate factors for effective treatment to improve their gait ability.

Methods: This study used an observational cross-sectional correlational design. Patients with adult spinal deformities (n=9; 3 men, 6 women; mean age, 67.9±9.7 yr) were recruited for the study.The variables were range of motion/muscle strength of the spine and lower limbs, radiographic sagittal alignment of the spine and pelvis and discrepancy in the TIA during standing and walking.The muscle strength of the spine was measured using isokinetic dynamometer for isometric back extensors muscle strength and time loaded standing (TLS) for back extensors muscle endurance. The radiographic sagittal alignment of the spine and pelvis were measured on lateral radiographs in standing. The TIA were measured in standing and during walking at 3m, 33m. Discrepancy in the TIA were calculated from the lateral image at 3m and 33m during walking minus the values of standing.

Results: Regarding range of motion, significant negative correlations were found between knee flexion range of motion (r=-0.70, p=0.035), rectus femoris flexibility (r=-0.68, p=0.045) and discrepancy in the TIA at 3m walking distance. Regarding muscle strength, significant negative correlation was found between TLS and discrepancy in the TIA at 33m walking distance (r=0.90, p=0.002); positive correlation was found between knee extensors muscle strength and discrepancy in the TIA at 3m walking distance (r=0.78, p=0.023). With regards to radiographic sagittal alignment, significant positive correlation was found between pelvic tilt which represent the degree of pelvic retroversion and discrepancy in the TIA at 3m walking distance (r=0.68, p=0.042).

Conclusions: Impairments of physical function and standing sagittal alignment, as assessed by the discrepancy in the trunk forward tilt between standing and gait, were knee flexion range of motion, rectus femoris flexibility, back extensors muscle endurance limitation and pelvic retroversion in patients with adult spinal deformity. However, these can be due to unknown causes and may require further investigation, especially for range of motion/muscle strength of the knee.

Implications: Our findings suggest that these factors should be targeted for assessment and treatment of patients with adult spinal deformities to improve their gait ability.

Funding acknowledgements: None.

Keywords:
adult spinal deformity
sagittal alignment
ROM / muscle strength

Topics:
Musculoskeletal: spine
Musculoskeletal

Did this work require ethics approval? Yes

Institution: North Alps Medical Center Azumi Hospital

Committee: Ethics Committee of North Alps Medical Center Azumi Hospital

Ethics number: 37557