Lightning Podiums: Adult Spinal Deformity - Room 801A

Presented by: A. Block


R. Haddas(1), I. Lieberman(2), A. Block(2)

(1) Texas Back Institute, Research Foundation, Plano, TX, United States
(2) Texas Back Institute, Plano, TX, United States


Background: Patients with adult degenerative scoliosis demonstrate an altered gait pattern. Among patients with chronic spine pain, fear-avoidance beliefs are predictive of behavioral deficiencies, poor work-related outcomes, and diminished surgical results. Psychological clinical outcome questionnaires (FABQ and TSK) are a reliable and valid measure of the fear of movement related to chronic lower back pain. Self-report measures are routinely used in the clinical setting to capture data related to back and leg pain symptoms, function and perceived disability. However, few studies have examined the correlation between the patients' psychological clinic outcome and neuromuscular variables as assessed by gait analysis.

Purpose: The purpose of this study was to determine the correlation between self-reported psychological assessments with objective neuromuscular measures of function.

Study Design: A non-randomized, prospective, concurrent control cohort study of patients with ADS.

Patient Sample: Thirty-four patients with symptomatic ADS who have been deemed appropriate surgical candidates.

Outcome Measures: Tampa Scale for Kinesiophobia (TSK) questionnaire and the Fear Avoidance Beliefs Questionnaire (FABQ) scores along with integrated electromyography (iEMG).

Methods: Clinical gait analysis was performed the week before surgery. External Oblique (EO), Multifidus (Mf) at the level of L5, Erector Spinae (ES) at the level of L1, Gluteus Maximus (GM), Rectus Femoris (RF), Semitendinosus (ST), Tibialis Anterior (TA), and Medial Gastrocnemius (MG) neuromuscular activity were measured and recorded during the gait analysis session. iEMG activity is a graphic representation of the sum total EMG activity over a defined period of time. In this fashion the total accumulated muscle activity can be computed for a chosen time period. Furthermore, the TSK and FABQ questionnaires were obtained on the same day of testing. Correlations were determined between the self-report fear of movement measures and the objective gait analysis neuromuscular data using Pearson´s Product Correlation in SPSS.

Results: The TSK was correlated with ES (r=0.40, p=0.030), GM (r=0.38, p=0.042), and GM (r=0.35, p=0.050) iEMGs. The FABQ physical activity portion was correlated with RF (r=0.41, p=0.048) and MG (r=-0.49, p=0.043) iEMGs. The FABQ work portion was correlated with Mf (r=-0.56, p=0.037), GM (r=-0.41, p=0.033), RF (r=-0.45, p=0.046), and TA (r=0.43, p=0.044) iEMGs.

Conclusions: This study demonstrated a strong correlation between biomechanical neuromuscular parameters as measured with gait analysis and fear and avoidance of movement as measured with the TSK and FABQ. Further, it demonstrates that there are different aspects of fear-avoidance that may influence neuromuscular activity. This study extends previous research on the role of fear-avoidance in the assessment of patients afflicted with adult degenerative scoliosis. Objective motor performance measures, especially gait analysis, could improve evaluation of spine disorder patients. Gait and mental disability are strongly correlated in surgical patients with adult spinal deformity.