General Session: Adult Spinal Deformity - Hall F

Presented by: I. Lieberman

Author(s):

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

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

Abstract

Introduction: Patients with adult degenerative scoliosis (ADS) demonstrate an altered gait pattern. Such differences include decreased step length and reduced range of motion in the upper and lower extremities, asymmetry of trunk rotation and altered ground reaction forces. Spinal alignment surgery has been shown to improve function and quality of life as assessed by patient reported disease specific and generic health clinical outcome questionnaires. These measures are considered objective, however can be misleading, inaccurate and lack sensitivity and specificity, due to multiple biases and data collection methods. The purpose of this study is to evaluate the utility of gait analysis as an objective outcome measure in patients with adult degenerative scoliosis before and after surgical intervention.

Method: Sixteen patients with symptomatic ADS who have been deemed appropriate surgical candidates underwent clinical gait analysis the week before surgery (Pre) and three months (Post) after surgery. Fifty reflective markers were incorporated to collect full body three-dimensional kinematics using 10 cameras. The patients walked at his/her self-selected speed along a 10 m walkway. Spatiotemporal parameters (i.e.: gait speed, cadence, step time, and step length and width) were calculated and analyzed with one way ANOVA to determine differences between times.

Results: Spinal alignment surgery improved the gait pattern in these ADS patients. A significantly faster walking speed (Pre: 0.80±0.1 vs Post: 0.91±0.2 m/s p=0.012) and cadence (Pre: 92.17±9.5 vs Post: 103.36±10.2 steps/min p=0.001) was measured at the three month post-surgery test in these patients in comparison to their pre-surgery. Step time (Left: Pre: 0.69±0.1 vs Post: 0.60±0.1 s p=0.004; Right: Pre: 0.64±0.1 vs Post: 0.58±0.1 s p=0.005), single support time (Left: Pre: 0.50±0.0 vs Post: 0.43±0.1 s p=0.006; Right: Pre: 0.49±0.1 vs Post: 0.43±0.0 s p=0.005) and double support time (Pre: 0.37±0.1 vs Post: 0.31±0.1 s p=0.003) dramatically decreased at three months after surgery. Step length and width did not significantly change after surgery.

Conclusions: Clinical gait analysis verified significant differences before and after spine surgery in those treated for adult degenerative scoliosis. Based on our preliminary results, surgical correction of spinal alignment in these patients' improved their spatiotemporal parameters. These patients walked faster in a more symmetrical and efficient fashion after spinal re-alignment surgery. These results support the utility of gait analysis as an objective outcome measure when evaluating and treating adult degenerative scoliosis patients. The use of gait analysis may be more sensitive and specific than the current patient reported outcome measures when evaluating patients with spinal deformities.