Are static sagittal compensation strategies preserved during walking in adult spinal deformity?
Introduction
To compensate for their aberrant sagittal malalignment, i.e. an important cause of pain and disability, patients with adult spinal deformity (ASD) use different musculoskeletal strategies. Although frequently described in static conditions, little is known about these compensations during dynamic conditions. Recently our research group reported that ASD patients with increased posterior pelvic tilt have decreased dynamic balance capacities, measured with the BESTest[1]. We assumed that patients were not able to maintain this compensating pelvic retroversion during more dynamic conditions. Therefore, the goal of this study is to quantify to what extent previously described compensatory changes in sagittal profile during standing are preserved during more dynamic motor tasks, i.e. gait. A secondary objective is to document to what extent discriminative features of their dynamic sagittal profile relate to clinically assessed balance performance.
Section snippets
Research Question
To what extent are static sagittal compensation strategies preserved during walking in ASD patients?
Methods
9 ASD patients and 7 healthy controls, not different in age (67,22 ± 2,52; 60,14 ± 7,71; p=0,143) and BMI (23,85 ± 2,73; 25,47 ± 2,09; p=0,45) were recruited for 3D motion analysis, using a 10 camera Vicon system, and balance assessment using the BESTest [2]. One static trial and 6 walking trials were processed (full body Plug-In-Gait model, Vicon Nexus) for calculating spatiotemporal and sagittal kinematic data of the spine and lower limb and statistically analyzed between and within groups
Discussion
Results indicate that patients with ASD partially omit statically-used sagittal compensation mechanisms (pelvic retroversion, knee flexion and ankle dorsiflexion) during walking. Although these changes in dynamic versus static sagittal parameters resemble the changes observed in healthy controls, the persisting increase in sagittal spine angle, combined with reduced compensations at pelvis, knee and ankle, may explain the impairments during gait and balance assessment, as demonstrated by the
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