Skip to main content
SpringerLink
Log in

Thoracic kyphosis and pelvic anteversion in patients with adult spinal deformity increase while walking: analyses of dynamic alignment change using a three-dimensional gait motion analysis system

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To determine dynamic changes of spinopelvic alignment while walking using a three-dimensional (3D) gait motion analysis in adult spinal deformity (ASD) patients.

Methods

This study included 20 ASD patients. The 3D gait motion analysis (Vicon) was performed during continuous walking to their limit. Dynamic parameters were obtained using reflective markers on the spinous processes, which were segmented into thoracic (T-), lumbar (L-), and whole spine (S-), sagittal spinal distance (SVA) and coronal one (CVA), sagittal spinal angle to the vertical axis (SA) and coronal one (CA), sagittal pelvic angle to the horizontal axis (P-SA) and coronal (P-CA), and thoracic limited spinal angle to the pelvic angle (T-P SA) and lumbar one (L-P SA). The dynamic variables at the final lap were compared with those at the first lap of an oval walkway.

Results

Spinal kyphotic deformity deteriorated significantly. As for pelvic angle, the mean P-SA parameters (first lap/final lap) were 3.2°/5.2°. Anteversion of pelvic sagittal angle increased significantly after continuous walking to their limit. In particular, regarding limited spinal angle to the pelvic angle, the mean T-P SA parameters were 30.5°/36.2° and L-P SA parameters were 6.4°/6.8°. Thoracic kyphotic angle increased significantly, but lumbar kyphotic angle did not change.

Conclusion

Decrease of thoracic kyphosis and pelvic retroversion has been recognized as a compensation for ASD on standing radiograph. Our 3D gait motion analysis to determine spinal balance found thoracic kyphosis and pelvic anteversion increased significantly in patients with ASD after continuous walking to the limit of their endurance until they were fatigued, indicating a failure of compensation for ASD.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Glassman SD, Bridwell K, Dimar JR et al (2005) The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 30:2024–2029

    Article  Google Scholar 

  2. Glassman SD, Berven S, Bridwell K et al (2005) Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976) 30:682–688

    Article  Google Scholar 

  3. Lafage V, Schwab F, Patel A et al (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976) 34:E599–E606. https://doi.org/10.1097/brs.1090b1013e3181aad1219

    Article  Google Scholar 

  4. Mac-Thiong JM, Transfeldt EE, Mehbod AA et al (2009) Can c7 plumbline and gravity line predict health related quality of life in adult scoliosis? Spine (Phila Pa 1976) 34:E519–E527. https://doi.org/10.1097/brs.1090b1013e3181a1099c1097ad

    Article  Google Scholar 

  5. Schwab F, Patel A, Ungar B et al (2010) Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976) 35:2224–2231. https://doi.org/10.1097/brs.0b013e3181ee6bd4

    Article  Google Scholar 

  6. Schwab F, Ungar B, Blondel B et al (2012) Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976) 37:1077–1082. https://doi.org/10.1097/brs.0b013e31823e15e2

    Article  Google Scholar 

  7. Lamartina C, Berjano P, Petruzzi M et al (2012) Criteria to restore the sagittal balance in deformity and degenerative spondylolisthesis. Eur Spine J 21:S27–S31. https://doi.org/10.1007/s00586-012-2236-9

    Article  PubMed  Google Scholar 

  8. Hasegawa K, Okamoto M, Hatsushikano S et al (2016) Normative values of spino-pelvic sagittal alignment, balance, age, and health-related quality of life in a cohort of healthy adult subjects. Eur Spine J 25:3675–3686

    Article  Google Scholar 

  9. Obeid I, Boissiere L, Yilgor C et al (2016) Global tilt: a single parameter incorporating spinal and pelvic sagittal parameters and least affected by patient positioning. Eur Spine J 25:3644–3649

    Article  CAS  Google Scholar 

  10. Miura K, Kadone H, Koda M et al (2018) Visualization of walking speed variation-induced synchronized dynamic changes in lower limb joint angles and activity of trunk and lower limb muscles with a newly developed gait analysis system. J Orthop Surg (Hong Kong) 26:2309499018806688. https://doi.org/10.1177/2309499018806688

    Article  Google Scholar 

  11. Miura K, Kadone H, Koda M et al (2018) Three-dimensional gait analysis reveals dynamic alignment change in a patient with dropped head syndrome: a case report. J Clin Neurosci 48:106–108. https://doi.org/10.1016/j.jocn.2017.10.075

    Article  PubMed  Google Scholar 

  12. Miura K, Koda M, Kadone H et al (2018) Successful detection of postoperative improvement of dynamic sagittal balance with a newly developed three-dimensional gait motion analysis system in a patient with iatrogenic flatback syndrome: a case report. J Clin Neurosci 53:241–243. https://doi.org/10.1016/j.jocn.2018.04.051

    Article  PubMed  Google Scholar 

  13. Haddas R, Belanger T (2017) Clinical gait analysis on a patient undergoing surgical correction of kyphosis from severe ankylosing spondylitis. Int J Spine Surg 11:18. https://doi.org/10.14444/4018

    Article  PubMed  PubMed Central  Google Scholar 

  14. Shiba Y, Taneichi H, Inami S et al (2016) Dynamic global sagittal alignment evaluated by three-dimensional gait analysis in patients with degenerative lumbar kyphoscoliosis. Eur Spine J 25:2572–2579. https://doi.org/10.1007/s00586-016-4648-4

    Article  PubMed  Google Scholar 

  15. Sasaki K, Hongo M, Miyakoshi N et al (2017) Evaluation of sagittal spine-pelvis-lower limb alignment in elderly women with pelvic retroversion while standing and walking using a three-dimensional musculoskeletal model. Asian Spine J 11:562–569. https://doi.org/10.4184/asj.2017.11.4.562

    Article  PubMed  PubMed Central  Google Scholar 

  16. Van Royen BJ, Toussaint HM, Kingma I et al (1998) Accuracy of the sagittal vertical axis in a standing lateral radiograph as a measurement of balance in spinal deformities. Eur Spine J 7:408–412

    Article  Google Scholar 

  17. Barrey C, Roussouly P, Perrin G et al (2011) Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms? Eur Spine J 20:626–633. https://doi.org/10.1007/s00586-011-1930-3

    Article  PubMed  PubMed Central  Google Scholar 

  18. Le Huec JC, Charosky S, Barrey C et al (2011) Sagittal imbalance cascade for simple degenerative spine and consequences: algorithm of decision for appropriate treatment. Eur Spine J 20:699–703. https://doi.org/10.1007/s00586-011-1938-8

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lamartina C, Berjano P (2014) Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms. Eur Spine J 23:1177–1189. https://doi.org/10.1007/s00586-014-3227-9

    Article  PubMed  Google Scholar 

  20. Lee JH, Lee SH (2016) Static and dynamic parameters in patients with degenerative flat back and change after corrective fusion surgery. Ann Rehabil Med 40:682–691. https://doi.org/10.5535/arm.2016.40.4.682

    Article  PubMed  PubMed Central  Google Scholar 

  21. Schmid S, Studer D, Hasler CC et al (2015) Using skin markers for spinal curvature quantification in main thoracic adolescent idiopathic scoliosis: an explorative radiographic study. PLoS ONE 10:e0135689. https://doi.org/10.1371/journal.pone.0135689

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan

    Kousei Miura, Masao Koda, Tetsuya Abe, Toru Funayama, Hiroshi Noguchi, Kentaro Mataki, Katsuya Nagashima, Hiroshi Kumagai, Yosuke Shibao & Masashi Yamazaki

  2. Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba Hospital, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan

    Kousei Miura

  3. Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan

    Hideki Kadone

  4. Center for Cybernics Research, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan

    Kenji Suzuki

Authors
  1. Kousei Miura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hideki Kadone
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masao Koda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tetsuya Abe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Toru Funayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroshi Noguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kentaro Mataki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Katsuya Nagashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hiroshi Kumagai
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yosuke Shibao
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kenji Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Masashi Yamazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kousei Miura.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 137 kb)

Supplementary material 2 (MP4 852 kb)

Supplementary material 3 (MP4 1022 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Miura, K., Kadone, H., Koda, M. et al. Thoracic kyphosis and pelvic anteversion in patients with adult spinal deformity increase while walking: analyses of dynamic alignment change using a three-dimensional gait motion analysis system. Eur Spine J 29, 840–848 (2020). https://doi.org/10.1007/s00586-020-06312-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-020-06312-y

Keywords

Search

Navigation