General Session: Innovative Technologies I - Hall F

Presented by: S. Kutz

Author(s):

R. Haddas(1), J. Cox(1), S. Kutz(2), R. Rashbaum(2)

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

Abstract

Study Design: A non-randomized, prospective, concurrent control cohort study of SI patients prior to any SI fusion surgery and healthy volunteer controls.

Background: The sacroiliac (SI) joint is cited as the source of pain in 15% to 30% of patients presenting with low back pain. Without previous lumbar fusion appearance for situation that indicates up to 47% in those patients. Many of these patients present with an altered gait pattern that enables them to off-load the painful joint. To our knowledge, no study exists that investigates the differences in gait pattern between patients with SI joint pain and those without. Defining the gait pattern in patients with SI joint pain will improve our understanding of the pathology and the compensatory mechanisms used to offload the SI joint. This knowledge may also aid in development of rehabilitation techniques and improve treatment success.

Purpose: The purpose of this study was to evaluate the spatiotemporal parameters during the gait cycle in adult patients with SI joint pain prior to any surgical intervention.

Patient Sample: Eleven patients with SI joint dysfunction who have been deemed appropriate surgical candidates were compared to 20 healthy controls (HC).

Outcome Measures: Walking speed, cadence, step time, length, and width.

Methods: Clinical gait analysis was performed on healthy controls and also in SI patients one week prior to SI fusion surgery. Spatiotemporal parameters were recorded using a video motion capture system. The data was analyzed with a one way ANOVA to determine differences between groups.

Results: SI joint pain patients had significantly an alter gait in comparison to healthy control. Walking speed (SI: 0.79±0.2 m/s vs HC: 1.11±0.1 m/s; p=0.001) and cadence (SI: 92.17±16.6step/min vs HC: 112.19±6.7step/m; p =0.001) were significantly lower in patients with SI joint pain. Similarly, step time (SI: 0.69±0.1s vs HC: 0.53±0.1s; p=0.001), single support time (SI: 0.47±0.1s vs HC: 0.41±0.0s; p=0.026), and double support time (SI: 0.40±0.1s vs HC: 0.26±0.1s; p=0.001) were significantly longer in patients with SI pain. Finally, step length (SI: 0.50±0.1m vs HC: 0.58±0.1m; p=0.001) was significantly shorter and step width (SI: 0.14±0.0m vs HC: 0.11±0.0m; p=0.035) was significantly wider in patients with SI joint pain.

Conclusions: The SI joint is responsible for load transfer between the pelvis and the spine, and pain in this joint can be debilitating. The altered gait mechanics in patients with SI joint pain are poorly understood and this study further defines the associated gait pattern. These patients compensate for pain in the SI joint by walking slower with a shorter, wider step than healthy patients. They also increase the single and double legged support time which is likely minimizing the amount of time the painful SI joint is transferring the body weight during gait. These results improve our understanding of compensatory mechanisms during gait in patients with SI joint pain. This information may be beneficial in developing rehabilitation techniques for these patients and also in analyzing the improvement of the gait pattern after specific treatments of SI joint pain.