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Gait Posture. 2018 Oct;66:181-188. doi: 10.1016/j.gaitpost.2018.08.015. Epub 2018 Aug 19.

Motion analysis in the axial plane after realignment surgery for adolescent idiopathic scoliosis.

Author information

1
Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, United States; Department of Spine Surgery, Methodist Hospitals, Merrillville, IN, United States.
2
Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, United States.
3
Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, United States. Electronic address: Neil.Shah@downstate.edu.
4
Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, United States; Department of Orthopaedic Surgery, Nassau University Medical Center, East Meadow, NY, United States.
5
Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, United States; Department of Physical Therapy, Long Island University, Brooklyn, NY, United States.
6
Spine Service, Hospital for Special Surgery, New York, NY, United States.
7
Division of Neurosurgery, Brookdale University Hospital Medical Center, Brooklyn, NY, United States.

Abstract

BACKGROUND:

This study aimed to define changes occurring in axial plane motion after scoliosis surgery in patients with adolescent idiopathic scoliosis (AIS) using gait analysis. Pre- and postoperative axial plane motion was compared to healthy/control subjects. This may potentially improve our understanding of how motion is impacted by deformity and subsequent surgical realignment.

METHODS:

15 subjects with AIS underwent pre- and postoperative radiographic and gait analysis, with focus on axial plane motion (clockwise [CW] and counterclockwise [CCW]). Age, weight, and gender-matched controls (n = 13) were identified for gait analysis. Control, preoperative and postoperative groups were compared with paired student's t-tests.

RESULTS:

Surgical realignment resulted in significantly decreased in upper thoracic, thoracic, thoracolumbar and lumbar Cobb angles pre-to-postoperatively (36.7° vs. 15.2°, 60.1° vs. 25.6°, 47.7° vs. 17.7° and 27.2° vs. 4.8°, respectively) (all p < 0.05), with no significant change in thoracic kyphosis, lumbar lordosis, central sacral vertical line, pelvic incidence, and sagittal vertical axis. However, pelvic tilt significantly increased from 4.9° to 8.1° (p = 0.035). Using gait analysis: preoperative thoracic axial rotation differed (mean CW and CCW rotation was 1.9° and 3.1° [p = 0.01]), whereas mean CW & CCW pelvic rotation remained symmetric (2.0° and 3.0°; p = 0.44). Postoperatively, CCW thoracic rotation range of motion decreased (CW: 0.6° and CCW: 1.4°; p = 0.31). No significant difference in postoperative pelvic rotation occurred (1.1° and 3.4°; p = 0.10). Compared to controls, AIS patients demonstrated no significant difference in total CW & CCW thoracic motion relative to the pelvis both pre- (14.9° and 12.3°, respectively; p = 0.45) and postoperatively (12.9° and 12.3°, respectively; p = 0.82).

SIGNIFICANCE:

AIS patients demonstrated abnormal gait patterns in the axial plane compared to normal controls. After surgical realignment and de-rotation, marked improvement in axial plane motion was observed, highlighting how motion analysis can afford surgeons three-dimensional perspective into the patient's functional status.

KEYWORDS:

Adolescent idiopathic scoliosis; Axial plane; Gait analysis; Motion analysis; Posterior spinal fusion; Postoperative changes

PMID:
30195821
DOI:
10.1016/j.gaitpost.2018.08.015
[Indexed for MEDLINE]

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