General Session: Adult Spinal Deformity

Presented by: R. Haddas - View Audio/Video Presentation (Members Only)


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


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 degenerative adult scoliosis and lead to segmental instability, deformity and stenosis. 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 biomechanical variables as assessed by gait analysis. The purpose of this study was to determine the correlation between self-reported psychological assessments 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, the Tampa Scale for Kinesiophobia (TSK) questionnaire and the Fear Avoidance Beliefs Questionnaire (FABQ) were obtained on the same day of testing. Correlations were determined between the self-report fear of movement measures and the objective gait analysis biomechanical data using Pearson´s Product Correlation in SPSS.

Results: The TSK was strongly correlated with gait speed (r=-0.76, p=0.001), stride length (r=-0.70, p=0.003), support time (r=0.81, p=0.001) and moderately correlated with sagittal knee angle (r=-0.67, p=0.013). The FABQ physical portion was strongly correlated with stride length (r=-0.75, p=0.001), frontal hip (r=0.70, p=0.008) and neck (r=-0.74, p=0.004) angles and moderately correlated with gait speed (r=-0.66, p=0.005), frontal pelvic (r=-0.69, p=0.009) and lumbar (r=0.56, p=0.047) angles. The FABQ work portion was moderately correlated with gait speed (r=-0.69, p=0.003), stride length (r=-0.66, p=0.005), support time (r=0.69, p=0.003), sagittal hip (r=0.58, p=0.038) and ankle (r=-0.68, p=0.011) angles, hip ROM (r=-0.69, p=0.009), frontal hip (r=0.60, p=0.029) and knee (r=0.64, p=0.018) angles and GRF (r=-0.55, p=0.050).

Discussion: This study demonstrated a strong correlation between biomechanical gait parameters as measured with gait analysis and fear and avoidance of movement as measured with the TSK and FABQ. Quantified gait analysis can be a useful tool to evaluate patients with spine deformity and to assess the outcomes of treatments in this group of patients. Objective motor performance measures, especially gait analysis, could improve evaluation of spine disorder patients.

Significance: Gait and mental disability are strongly correlated in surgical patients with adult spinal deformity. Quantified gait analysis can be a useful tool to evaluate patient outcomes.