General Session: Biomechanics
Presented by: R. Haddas - View Audio/Video Presentation (Members Only)
R. Haddas(1), S. Aghyarian(1), I. Lieberman(2)
(1) Texas Back Institute, Research Foundation, Plano, TX, United States
(2) Texas Back Institute, Plano, TX, United States
Introduction: Patients with adult degenerative scoliosis demonstrate an altered gait pattern. Age related changes such as progressive and asymmetric degeneration of the disc and facet joints are associated with adult degenerative scoliosis and lead to segmental instability, deformity and stenosis. Self-reported measures are routinely used in the clinical setting to capture data related to back and leg pain symptoms, function and perceived disability, in the setting of adult degenerative scoliosis. However, few studies have examined the correlation between patients' self-reported clinical outcome and objective biomechanical gait analysis. The purpose of this study was to determine the correlation between self-reported assessments of function with objective biomechanical measures of function.
Methods: Data were prospectively collected from patients (N=20) with symptomatic adult degenerative scoliosis who were deemed appropriate surgical candidates. Clinical gait analysis was performed the week before surgery. Spine and lower extremity angle and range of motion (ROM), ground reaction force (GRF), along with spatiotemporal variables were measured and recorded during the gait analysis session. Furthermore, back pain and leg pain VAS, ODI scores, SRS22 scores were obtained on the same day of testing. Correlations were determined between the self-report clinical outcome questionnaire measures and objective gait analysis biomechanical data using Pearson´s Product Correlation in SPSS.
Results: The Oswestry Disability Index (ODI) was strongly correlated with gait speed (r=-0.76, p=0.001), stride length (r=-0.74, p=0.001), support time (r=0.76, p=0.001) and moderately correlated with frontal hip (r=-0.59, p=0.033) and lumbar (r=0.57, p=0.040) ROM. The leg Visual Analogue Scale (VAS) was strongly correlated with gait speed (r=-0.71, p=0.001) and moderately correlated with stride length (r=-0.60, p=0.015), support time (r=0.60, p=0.014) sagittal knee angle (r=-0.66, p=0.013), frontal hip angle (r=-0.63, p=0.021) and neck angle (r=-0.58, p=0.040). The low back VAS was moderately correlated with stride length (r=-0.56, p=0.025), frontal hip (r=-0.69, p=0.010) and neck (r=-0.64, p=0.019) ROM. The Scoliosis Research Society Questionnaires (SRS22r) was strongly correlated with gait speed (r=0.72, p=0.002) and moderately correlated with stride length (r=-0.64, p=0.010), support time (r=-0.67, p=0.006), sagittal head angle (r=-0.62, p=0.032) and GRF (r=-0.60, p=0.039). The SRS22 function subset showed a similar result with moderate correlation with sagittal knee ROM (r=0.59, p=0.043), frontal hip (r=0.66, p=0.021) and lumbar (r=0.60, p=0.038) ROM.
Discussion: This study demonstrated a strong correlation between biomechanical parameters as measured with objective gait analysis and functional disability as measured with patient reported outcome measures including the ODI, VAS and SRS22. Quantified gait analysis can be a useful tool to evaluate patients with spine deformity and to assess the outcomes of treatment in this group of patients. Objective motor performance measures, especially gait analysis, will improve the evaluation and understanding of the biomechanical effects of spinal disorders on locomotion. Gait and disability are strongly correlated in surgical patients with adult degenerative scoliosis. Quantified gait analysis can be a useful tool to evaluate patient outcomes.