Adult Spinal Deformity
Conditions
Keywords
ASD
Brief summary
This study intends to investigate the changes in gait pattern in adult spinal deformity (ASD) patients with sagittal imbalance. It will investigate the gait kinematics in patients who have a mismatch of their spinopelvic parameters, and a positive sagittal balance. The investigators hypothesise that patients with abnormal spinopelvic parameters may demonstrate a pathological gait pattern.
Detailed description
With an ageing population, ASD presents as a significant health issue with increasing incidence. Most of the earlier literature concentrated on radiographic measurements of the deformity in the coronal plane, and its surgical correction. However, recent publications have demonstrated that sagittal spinopelvic alignment plays a critical role in pain and disability in patients with ASD, and is a primary determinant of health related quality of life measures. There is substantial evidence that restoration of these parameters after spinal reconstructive surgery is correlated with good clinical outcome. Maintenance of the ideal sagittal alignment allows an individual to maintain an erect posture with minimal energy expenditure. When there is progressive loss of lumbar lordosis, compensatory mechanisms involving the pelvis, hips and knees occur to extend adjacent segments of the kyphotic spine to allow for compensation of anterior translation of the axis of gravity. However, this compensatory mechanism may potentially result in adverse effect. One of the main disabilities in ASD patients with sagittal imbalance is their decreased walking tolerance. The change in the spinal alignment along with these compensatory mechanisms may result in an inefficient gait worsening their walking tolerance. Few studies in the literature have investigated the changes in gait pattern in patients with sagittal imbalance. Of those, the patient group was heterogeneous, and the only criterion of sagittal imbalance was a positive sagittal vertical axis (SVA), which the investigators now know is not a complete assessment of the sagittal alignment. The investigators propose to study the change in gait pattern in individuals with abnormal spinopelvic parameters, and how this may affect their quality of lives.
Interventions
DIAGNOSTIC_TESTGait Analysis
All patients will undergo gait analysis using reflective surface markers placed at different locations on the head, trunk, upper and lower extremities, and pelvis. All patients will complete an analog pain scale, Oswestry, and SRS-22 questionnaires. These are health-related quality of life questionnaires that provide subjective assessment.
Sponsors
The University of Hong Kong
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
All patients diagnosed with ASD, fulfilling the following radiographic criteria based on whole spine lateral film are eligible for recruitment: * SVA bigger than 47mm * Pelvic tilt (PT) bigger than 22deg * Pelvic incidence (PI) - lumbar lordosis (LL) bigger than 11deg
Exclusion criteria
* If the aetiology of the ASD of the patient is neuromuscular origin * other pathologies that may affect their gait such as previous trauma or surgeries to the pelvis or the lower limbs and joint replacements * inability to walk without aids for short distances
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Evaluate the effect of sagittal imbalance on the gait cycle using reflective surface markers | 1 year | To evaluate the effect of sagittal imbalance on the gait cycle using reflective surface markers |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Investigate the difference in gait kinematics between normal and abnormal sagittal balance using reflective surface markers | 1 year | To investigate the difference in gait kinematics between normal and abnormal sagittal balance using reflective surface markers |
| Investigate the efficiency in gait differences between normal and abnormal sagittal balance using reflective surface markers | 1 year | To investigate the efficiency in gait differences between normal and abnormal sagittal balance using reflective surface markers |
| Investigate different muscle recruitment in gait cycles between normal and abnormal sagittal balance using a submaximal graded exercise test | 1 year | To investigate different muscle recruitment in gait cycles between normal and abnormal sagittal balance using a submaximal graded exercise test |
Countries
Hong Kong
Outcome results
None listed