Dynamic sagittal alignment and compensation strategies in adult spinal deformity during walking

Severijns, Pieter; Moke, Lieven; Overbergh, Thomas; Beaucage-Gauvreau, Erica; Ackermans, Thijs; Desloovere, Kaat; Scheys, Lennart

doi:10.1016/j.spinee.2021.02.017

Cited by 31 publications

(25 citation statements)

References 49 publications

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“…However, energy expenditure at the level of the knees was increased and spine kinematics were not studied (Bailey et al, 2019). In other studies, alterations in limb kinematics and spatio-temporal parameters during gait were not corrected postoperatively (Severijns et al, 2021). This highlights the need for future studies that would be able to assess the effect of surgery on daily life activities and that could determine which subset of ASD patients might benefit the most from surgical interventions.…”

Section: Discussionmentioning

confidence: 97%

“…As mentioned earlier, in the static standing position, knee flexion acts as a compensation mechanism that repositions the center of gravity above the feet. The same mechanism is also maintained during walking, therefore limiting knee extension and leading to decreased knee ROM during gait and eventually decreased step length ( Kawkabani et al, 2021 ; Severijns et al, 2021 ). However, in the static sitting position, the height of the seat was adjusted so that all individuals had the same initial knee flexion of 90°.…”

Section: Discussionmentioning

confidence: 99%

“…Kawkabani et al have shown that ASD subjects walked slower with an increased double support phase, and maintained a flexed attitude in their thorax, hips, and knees while walking (Kawkabani et al, 2021). Severijns et al also described a similar finding in ASD subjects with a decompensated sagittal deformity (Severijns et al, 2021). Although walking is an essential activity in daily life, limitations in other activities are usually observed when collecting HRQOL outcomes.…”

Section: Introductionmentioning

confidence: 96%

See 2 more Smart Citations

Alteration of the Sitting and Standing Movement in Adult Spinal Deformity

Saad

Semaan

Kawkabani

et al. 2022

Front. Bioeng. Biotechnol.

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Adults with spinal deformity (ASD) are known to have spinal malalignment affecting their quality of life and daily life activities. While walking kinematics were shown to be altered in ASD, other functional activities are yet to be evaluated such as sitting and standing, which are essential for patients’ autonomy and quality of life perception. In this cross-sectional study, 93 ASD subjects (50 ± 20 years; 71 F) age and sex matched to 31 controls (45 ± 15 years; 18 F) underwent biplanar radiographic imaging with subsequent calculation of standing radiographic spinopelvic parameters. All subjects filled HRQOL questionnaires such as SF36 and ODI. ASD were further divided into 34 ASD-sag (with PT > 25° and/or SVA >5 cm and/or PI-LL >10°), 32 ASD-hyperTK (with only TK >60°), and 27 ASD-front (with only frontal malalignment: Cobb >20°). All subjects underwent 3D motion analysis during the sit-to-stand and stand-to-sit movements. The range of motion (ROM) and mean values of pelvis, lower limbs, thorax, head, and spinal segments were calculated on the kinematic waveforms. Kinematics were compared between groups and correlations to radiographic and HRQOL scores were computed. During sit-to-stand and stand-to-sit movements, ASD-sag had decreased pelvic anteversion (12.2 vs 15.2°), hip flexion (53.0 vs 62.2°), sagittal mobility in knees (87.1 vs 93.9°), and lumbar mobility (L1L3-L3L5: −9.1 vs −6.8°, all p < 0.05) compared with controls. ASD-hyperTK showed increased dynamic lordosis (L1L3–L3L5: −9.1 vs −6.8°), segmental thoracic kyphosis (T2T10–T10L1: 32.0 vs 17.2°, C7T2–T2T10: 30.4 vs 17.7°), and thoracolumbar extension (T10L1–L1L3: −12.4 vs −5.5°, all p < 0.05) compared with controls. They also had increased mobility at the thoracolumbar and upper-thoracic spine. Both ASD-sag and ASD-hyperTK maintained a flexed trunk, an extended head along with an increased trunk and head sagittal ROM. Kinematic alterations were correlated to radiographic parameters and HRQOL scores. Even after controlling for demographic factors, dynamic trunk flexion was determined by TK and PI-LL mismatch (adj. R2 = 0.44). Lumbar sagittal ROM was determined by PI-LL mismatch (adj. R2 = 0.13). In conclusion, the type of spinal deformity in ASD seems to determine the strategy used for sitting and standing. Future studies should evaluate whether surgical correction of the deformity could restore sitting and standing kinematics and ultimately improve quality of life.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

See 1 more Smart Citation

Alteration of the Sitting and Standing Movement in Adult Spinal Deformity

Saad

Semaan

Kawkabani

et al. 2022

Front. Bioeng. Biotechnol.

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“…Traditional stereophotogrammetric models [ 7 , 8 , 9 , 10 , 11 ] were used to assess the kinematics of pelvis, hip, knee, ankle, trunk (considered as a single rigid segment that does not provide information on kinematic changes within the spine) and rarely head and upper limbs. A few studies analyzed the multi-segmental-trunk, head, lower- and upper- limbs kinematics in upright standing [ 12 , 13 , 14 ] by introducing a larger number of skin markers on the body; other ones assessed the trunk in several districts during locomotion or elementary exercises [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. In particular, [ 15 ] described spine kinematics considering lower-thoracic, lumbar and pelvic segments during walking; [ 16 ] characterized spine motion by 5-link-segment-model to upright posture, chair raising-sitting, stepping up and down, and level walking, and [ 17 ] investigated the contribution of upper-body movements to dynamic balance control during different and challenging motor tasks.…”

Section: Introductionmentioning

confidence: 99%

Kinematic Evaluation of the Sagittal Posture during Walking in Healthy Subjects by 3D Motion Analysis Using DB-Total Protocol

Blasiis

Fullin

Sansone

et al. 2022

JFMK

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Posture can be evaluated by clinical and instrumental methods. Three-dimensional motion analysis is the gold standard for the static and dynamic postural assessment. Conventional stereophotogrammetric protocols are used to assess the posture of pelvis, hip, knee, ankle, trunk (considered as a single segment) and rarely head and upper limbs during walking. A few studies also analyzed the multi-segmental trunk and whole-body kinematics. Aim of our study was to evaluate the sagittal spine and the whole-body during walking in healthy subjects by 3D motion analysis using a new marker set. Fourteen healthy subjects were assessed by 3D-Stereophotogrammetry using the DB-Total protocol. Excursion Range, Absolute Excursion Range, Average, intra-subject Coefficient of Variation (CV) and inter-subject Standard Deviation Average (SD Average) of eighteen new kinematic parameters related to sagittal spine and whole-body posture were calculated. The analysis of the DB-Total parameters showed a high intra-subject (CV < 50%) and a high inter-subject (SD Average < 1) repeatability for the most of them. Kinematic curves and new additional values were reported. The present study introduced new postural values characterizing the sagittal spinal and whole-body alignment of healthy subjects during walking. DB-Total parameters may be useful for understanding multi-segmental body biomechanics and as a benchmark for pathological patterns.

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“…Spinal alignment measurement in spinal deformity research has recently shifted from using mainly two-dimensional (2D) static radiography ( Schwab et al, 2012 ; Smith et al, 2013 ; Ailon et al, 2015 ) toward skin marker-based motion capture approaches. This allows three-dimensional (3D) assessment during both static positions and dynamic conditions, including daily life motor tasks ( Schmid et al, 2016 ; Diebo et al, 2018 ; Severijns et al, 2020 , 2021 ). However, the validity and accuracy of such skin marker-based methods is highly dependent on correct marker placement, which is known to be one of the main sources of variability in kinematic results ( Della Croce et al, 2005 ; Gorton et al, 2009 ; McFadden et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Spinal Palpation Error and Its Impact on Skin Marker-Based Spinal Alignment Measurement in Adult Spinal Deformity

Severijns

Overbergh

Schmid

et al. 2021

Front. Bioeng. Biotechnol.

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Spinal alignment measurement in spinal deformity research has recently shifted from using mainly two-dimensional static radiography toward skin marker-based motion capture approaches, allowing three-dimensional (3D) assessments during dynamic conditions. The validity and accuracy of such skin marker-based methods is highly depending on correct marker placement. In this study we quantified, for the first time, the 3D spinal palpation error in adult spinal deformity (ASD) and compared it to the error in healthy spines. Secondly, the impact of incorrect marker placement on the accuracy of marker-based spinal alignment measurement was investigated. 3D, mediolateral and inferosuperior palpation errors for thoracolumbar and lumbar vertebral levels were measured on biplanar images by extracting 3D positions of skin-mounted markers and their corresponding anatomical landmarks in 20 ASD and 10 healthy control subjects. Relationships were investigated between palpation error and radiographic spinal alignment (lordosis and scoliosis), as well as body morphology [BMI and soft tissue (ST) thickness]. Marker-based spinal alignment was measured using a previously validated method, in which a polynomial is fit through the marker positions of a motion trial and which allows for radiograph-based marker position correction. To assess the impact of palpation error on spinal alignment measurement, the agreement was investigated between lordosis and scoliosis measured by a polynomial fit through, respectively, (1) the uncorrected marker positions, (2) the palpation error-corrected (optimal) marker positions, and (3) the anatomically corrected marker positions (toward the vertebral body), and their radiographic equivalents expressed as Cobb angles (ground truth), using Spearman correlations and root mean square errors (RMSE). The results of this study showed that, although overall accuracy of spinal level identification was similar across groups, mediolateral palpation was less accurate in the ASD group (ASDmean: 6.8 mm; Controlmean: 2.5 mm; p = 0.002). Significant correlations with palpation error indicated that determining factors for marker misplacement were spinal malalignment, in particular scoliotic deformity (r = 0.77; p < 0.001), in the ASD group and body morphology [i.e., increased BMI (rs = 0.78; p = 0.008) and ST thickness (rs = 0.66; p = 0.038)] in healthy spines. Improved spinal alignment measurements after palpation error correction, shows the need for radiograph-based marker correction methods, and therefore, should be considered when interpreting spinal kinematics.

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Dynamic sagittal alignment and compensation strategies in adult spinal deformity during walking

Cited by 31 publications

References 49 publications

Alteration of the Sitting and Standing Movement in Adult Spinal Deformity

Alteration of the Sitting and Standing Movement in Adult Spinal Deformity

Kinematic Evaluation of the Sagittal Posture during Walking in Healthy Subjects by 3D Motion Analysis Using DB-Total Protocol

Spinal Palpation Error and Its Impact on Skin Marker-Based Spinal Alignment Measurement in Adult Spinal Deformity

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