Texas Back Institute, Plano, TX, 75093, USA.
Texas Back Institute, Plano, TX, 75093, USA.
Spine J. 2021 Mar;21(3):518-527. doi: 10.1016/j.spinee.2020.09.009. Epub 2020 Sep 20.
Surgical correction strategies for adult spinal deformity (ASD) relies heavily on radiographic alignment goals, however, there is often debate regarding degree of correction and how static alignment translates to physical ability in daily life. Kinematic analysis has the potential to improve the concept of ideal spinal alignment by providing clinically meaningful estimates of dynamic changes in spinal alignment during activities of daily life.
Estimate representative dynamic ranges of spinal alignment during gait among ASD patients using 3D motion tracking; compare dynamic alignment between mild and severe deformity patients and to healthy adults.
STUDY DESIGN/SETTING: Retrospective review at a single institution.
Fifty-two ASD patients and 46 healthy adults.
Radiographic alignment, kinematic spine motion, spatiotemporal gait measures, patient reported outcomes (VAS pain, ODI, SRS-22r).
Spinal alignment was assessed radiographically and during standing and overground walking tests. Dynamic alignment was initialized by linking radiographic alignment to kinematic alignment during standing and at initial heel contact during gait. Dynamic changes in maximums and minimums during gait were made relative to initial heel contact for each gait cycle. Total range-of-motion (RoM) was measured for both ASD and healthy subjects. Dynamic alignment measures included coronal and sagittal vertical axes (CVA, SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), and pelvic tilt (PT). ASD patient's deformities were classified as either Mild or Severe based on the SRS-Schwab ASD classification.
Severe ASD patients had significantly larger dynamic maximum and minimums for SVA, TPA, LL, and PT (all p<.05) compared with Mild ASD patients. ASD patients exhibited little difference in dynamic alignment compared with healthy subjects. Only PT had a significant difference in dynamic RoM compared with healthy (p<.001).
Mild and Severe ASD patients exhibited similar global dynamic alignment measures during gait and had comparable RoM to healthy subjects except with greater PT and reduced spatiotemporal performance which may be key compensatory mechanisms for dynamic stabilization.
成人脊柱畸形（ASD）的手术矫正策略严重依赖于影像学的对线目标，但在矫正程度以及静态对线如何转化为日常生活中的身体能力方面，常常存在争议。运动学分析有可能通过提供日常生活中脊柱对线动态变化的临床有意义的估计，来改善理想脊柱对线的概念。
使用三维运动跟踪技术估计 ASD 患者在步态中的脊柱对线的代表性动态范围；比较轻度和重度畸形患者与健康成年人之间的动态对线。
研究设计/设置：单中心回顾性研究。
52 例 ASD 患者和 46 例健康成年人。
影像学对线、脊柱运动学、时空步态测量、患者报告的结果（VAS 疼痛、ODI、SRS-22r）。
通过影像学和站立及地面步行测试评估脊柱对线。在站立和步态初始足跟接触时，通过将影像学对线与运动学对线相联系，对线进行初始设置。相对于每个步态周期的初始足跟接触，确定步态中最大值和最小值的动态变化。为 ASD 和健康受试者测量总活动范围（RoM）。动态对线测量指标包括冠状位和矢状位垂直轴（CVA、SVA）、T1 骨盆角（TPA）、腰椎前凸（LL）和骨盆倾斜（PT）。根据 SRS-Schwab ASD 分类，将 ASD 患者的畸形分为轻度或重度。
与轻度 ASD 患者相比，重度 ASD 患者的 SVA、TPA、LL 和 PT 的动态最大和最小值显著更大（均 p<.05）。与健康受试者相比，ASD 患者的动态对线差异不大。仅 PT 在动态 RoM 方面与健康受试者存在显著差异（p<.001）。
轻度和重度 ASD 患者在步态中表现出相似的整体动态对线测量值，与健康受试者的 RoM 相当，但 PT 更大，时空表现更差，这可能是动态稳定的关键代偿机制。
