General Session: Adult Spinal Deformity - Hall F

Presented by: I. Lieberman


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

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


Purpose: To determine the correlation between self-reported assessments of function with objective biomechanical measures of function.

Introduction: Patients with adult degenerative scoliosis (ADS) demonstrate an altered gait and balance patterns. Balance is defined as the ability of the human body to maintain its center of mass (COM) within the base of support with minimal postural sway. Self-reported measures are routinely used in the clinical setting to capture data related to function and perceived disability, in the setting of ADS. However, few studies have examined the correlation between patients' self-reported clinical outcome and objective biomechanical gait and balance analyses.

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

Methods: Gait and functional balance analyses were performed the week before surgery. Spatiotemporal parameters (i.e. gait speed, cadence, stride length, width and time etc.) were calculated during the gait evaluation. The functional balance test was similar to a Romberg´s test. COM and head displacements in the sagittal and coronal planes and total sway amount were calculated. Furthermore, Scoliosis Research Society Questionnaires (SRS22r) scores were obtained on the same day of testing. Correlations were determined between the self-report clinical outcome questionnaire measures and objective gait and balance analyses biomechanical data using Pearson´s Product Correlation in SPSS.

Outcome Measures: Dependent variables included SRS22r scores along with gait spatiotemporal parameters and COM and head sway during functional balance test.

Results: The SRS22r total score was correlated with stride length (r=0.37, p=0.050) during gait and COM total sway (r=-0.41, p=0.027), horizontal COM sway in the sagittal (r=-0.54, p=0.002) and coronal (r=-0.39, p=0.050) planes, and horizontal head sway in the sagittal (r=-0.41, p=0.029) during the balance test. Detailed analysis was performed on the SRS22r different section scores. The SRS22r function score was correlated with COM total sway (r=-0.44, p=0.017), horizontal COM (r=-0.55, p=0.002), and head(r=-0.40, p=0.030) sway in the sagittal plane during the balance test. The SRS22r pain score was correlated with horizontal COM (r=-0.52, p=0.004), and head(r=-0.36, p=0.050) sway in the sagittal plane during the balance test. The SRS22r self-image score was correlated with cadence (r=-0.32, p=0.040), stride time (r=0.36, p=0.016), single support time (r=0.35, p=0.025), and stride length (r=0.32, p=0.050) during gait. The SRS22r mental health score was correlated with stride length (r=0.37, p=0.050) during gait and horizontal COM sway in the sagittal plane (r=-0.40, p=0.033) during the balance test. The SRS22r satisfaction score was correlated with walking speed (r=-0.33, p=0.027) during gait and base of support width (r=0.38, p=0.050) during the balance test.

Discussion: This study demonstrated a strong correlation between biomechanical parameters as measured with objective gait and balance analyses and functional disability as measured with patient reported outcome measures including the SRS22r. Quantified gait and balance analyses can be a useful tool to evaluate patient outcomes. Objective motor performance measures 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 ADS.