Haddas Ram, Belanger Theodore
Texas Back Institute Research Foundation, Plano, TX, USA.
Texas Back Institute, Rockwall, TX, USA.
Int J Spine Surg. 2017 Jun 21;11(3):18. doi: 10.14444/4018. eCollection 2017.
Ankylosing spondylitis (AS) is a chronic inflammatory disease primarily affecting the axial skeleton, including the sacroiliac joints, costovertebral joints, and the spine. Patients with AS found to have an alter gait pattern. The purpose of this study was to investigate biomechanical alterations in gait after surgical correction in a patient with severe kyphosis from AS.
A case report in controlled laboratory study, a pretest-posttest design. A 20 year-old male presented with severe sagittal imbalance and inability to stand erect due to AS. He presented with thoracic kyphosis of 70°, lumbar kyphosis of 25°, and pelvic incidence of 43°. The patient had a complex spinal reconstruction with 84° of sagittal correction, normalizing his sagittal alignment. Gait analysis was performed the day before surgery and one month post surgery, including three-dimensional kinematics, ground reaction forces, and electromyography outcomes.
Normalization of spinal alignment minimally increased walking speed and cadence. Lower extremity ranges of motion angles increased, but were not symmetrical even one month post surgery. Postoperatively, trunk flexion, neck extension and head orientation angles decreased compared with preoperative values, but was not symmetrical even one month post surgery. The trunk muscles were activated earlier in the post surgery condition compared to the pre surgery condition while lower extremity muscles presented later muscle activation.
Surgical correction of spinal alignment improved spine function and efficiency. Changes in gait abnormality parameters observed imply that the patient used less energy to ambulate after surgery than before surgery. Although pre-surgery data showed compensation in the spine kinematics, post-surgery data supported significant changes in the spine and the lower extremity values.
Formal gait and motion analysis can provide a method to assess the impact of severe spinal deformity on function and changes after treatment.
强直性脊柱炎（AS）是一种主要影响中轴骨骼的慢性炎症性疾病，包括骶髂关节、肋椎关节和脊柱。强直性脊柱炎患者存在步态模式改变。本研究的目的是调查一名强直性脊柱炎导致严重脊柱后凸患者手术矫正后步态的生物力学改变。
一项对照实验室研究中的病例报告，采用前后测试设计。一名20岁男性因强直性脊柱炎出现严重矢状面失衡且无法直立。他的胸椎后凸为70°，腰椎后凸为25°，骨盆倾斜角为43°。该患者接受了复杂的脊柱重建手术，矢状面矫正84°，使其矢状面排列恢复正常。在手术前一天和术后一个月进行步态分析，包括三维运动学、地面反作用力和肌电图结果。
脊柱排列恢复正常使步行速度和步频略有增加。下肢运动角度范围增加，但即使在术后一个月也不对称。术后，与术前相比，躯干前屈、颈部伸展和头部定向角度减小，但即使在术后一个月也不对称。与术前相比，术后躯干肌肉更早被激活，而下肢肌肉的激活时间较晚。
脊柱排列的手术矫正改善了脊柱功能和效率。观察到的步态异常参数变化表明，患者术后行走比术前消耗的能量更少。虽然术前数据显示脊柱运动学存在代偿，但术后数据支持脊柱和下肢值有显著变化。
正式的步态和运动分析可以提供一种方法来评估严重脊柱畸形对功能的影响以及治疗后的变化。
