Oral Posters: Adult Spinal Deformity
Presented by: R. Haddas - View Audio/Video Presentation (Members Only)
R. Haddas(1), A. Bozzio(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: For many patients with adult degenerative scoliosis, a walking aid is beneficial. Clinical experience has shown the use of walking sticks rather than a walker promotes a more upright posture. The walking sticks are beneficial pre-operatively not only in terms of deformity progression and line of sight, but also for patients postoperatively to help maintain surgical correction of their kyphotic deformities. Whereas a walker forces patients into kyphosis, the higher grips of walking sticks allows for more upright posture and improved sagittal alignment. The purpose of this study was to evaluate both the spatiotemporal and kinematic relationships of the lower extremities and spine during gait with walking sticks versus a walker in adult patients with degenerative scoliosis.
Methods: Twenty patients with symptomatic degenerative scoliosis who were deemed appropriate surgical candidates underwent gait analysis under 3 testing conditions; 1. With walking sticks (WS), 2. With walker (WR), and 3. Without any walking device (NW). Fifty-one reflective markers were incorporated to collect full body three-dimensional kinematics using 10 cameras. Ground reaction forces (GRFs) were measured using three parallel force plates. The patients walked at self-selected speeds along a 10 m walkway. Clinical gait analysis parameters were calculated from kinematic and kinetic data, including spatiotemporal parameters, lower extremity and spine joint angles at initial contact, as well as range of motion (ROM) and peak GRF. The data was analyzed with one way ANOVA with Bonferroni Post Hoc analyses to determine differences in walking devices.
Results: The use of walking sticks resulted in significant slower walking speed (WS:0.49 vs. WR:0.65 m/s, p< 0.014) and cadence (WS:58.91 vs. WR:76.00 step/min, p< 0.010; WS:58.91 vs. NW:87.96 step/min, p< 0.014). Stride and step times were longer compared to the walker (WS:2.26 vs. WR:1.64 s p< 0.002 and WS:1.08 vs. WR:0.82 s p< 0.001, respectively) and with no device (WS:2.26 vs. NW:1.40 s p< 0.001 and WS:1.08 vs. NW:0.71 s p< 0.001, respectively). Walking sticks resulted in a significantly larger dorsiflexion angle at initial contact (Right:6.9° p< 0.02; Left:6.4° p< 0.033) in comparison to the walker. Head orientation presented with a less extended position using the walking sticks (WS:-12.09 vs. WR:-18.56° p< 0.050; NW:-11.79 vs. WR:-18.56° p< 0.050). The use of the walking sticks significantly increased ankle (21.6° p< 0.002), knee (24.6° p< 0.015), and hip (15.0° p< 0.001) flexion ROM in comparison to the walker. Moreover, the walking sticks promoted more knee (15.6° p< 0.001), hip (3.9° p< 0.001), and head (4.0° p< 0.001) ROM in the frontal plane in comparison to a walker.
Discussion: The clinical findings of less kyphotic posture with the use of walking sticks were verified through gait analysis in this study. Although there were clear improvements in sagittal kinematic parameters to support the findings of a more upright walking position, there was also slower cadence and walking speed. This was attributed to patient unfamiliarity with walking sticks as the gait analysis was the first time patients had used these devices. With preoperative walking stick training, surgical correction of deformity, and postoperative use of walking sticks, improvement in both sagittal parameters and kinematics as compared to a walker can be expected.