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Effects of Spinal Fusion for Idiopathic Scoliosis on Lower Body Kinematics During Gait

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Abstract

Study Design

Prospective.

Objectives

The purpose of this study was to compare gait among patients with scoliosis undergoing posterior spinal fusion and instrumentation (PSFI) to typically developing subjects and determine if the location of the lowest instrumented vertebra impacted results.

Summary of Background Data

PSFI is the standard of care for correcting spine deformities, allowing the preservation of body equilibrium while maintaining as many mobile spinal segments as possible. The effect of surgery on joint motion distal to the spine must also be considered. Very few studies have addressed the effect of PSFI on activities such as walking and even fewer address how surgical choice of the lowest instrumented vertebra (LIV) influences possible motion reduction.

Methods

Individuals with scoliosis undergoing PSFI (n = 38) completed gait analysis preoperatively and at postoperative years 1 and 2 along with a control group (n = 24). Comparisons were made with the control group at each time point and between patients fused at L2 and above (L2+) versus L3 and below (L3–).

Results

The kinematic results of the AIS group showed some differences when compared to the Control Group, most notably decreased range of motion (ROM) in pelvic tilt and trunk lateral bending. When comparing the LIV groups, only minor differences were observed, and the results showed decreased coronal trunk and pelvis ROM at the one-year visit and decreased hip rotation ROM at the two-year visit in the L3– group.

Conclusions

Patients with AIS showed decreased ROM preoperatively with further decreases postoperatively. These changes remained relatively consistent following the two-year visit, indicating that most kinematic changes occurred in the first year following surgery. Limited functional differences between the two LIV groups may be due to the lack of full ROM used during normal gait, and future work could address tasks that use greater ROM.

Level of Evidence

Level II.

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Author information

Authors and Affiliations

  1. Orthopaedic & Rehabilitation Engineering Center, Marquette University, 1250 W Wisconsin Ave, 1515 W. Wisconsin Ave, 53233, Milwaukee, WI, USA

    Karen M. Kruger PhD, Christina M. R. Garman PhD, Joseph J. Krzak PhD, Adam Graf MS & Gerald F. Harris

  2. Motion Analysis Laboratory, Shriners Hospitals for Children, 2211 N Oak Park Ave, 60707, Chicago, IL, USA

    Joseph J. Krzak PhD, Adam Graf MS, Sahar Hassani MS, Kim W. Hammerberg MD, Purnendu Gupta MD & Gerald F. Harris

  3. College of Health Sciences, Midwestern University, 555 31st, 60515, Downers Grove, IL, USA

    Joseph J. Krzak PhD

  4. Division of Biostatistics, Medical College of Wisconsin, 8701 W. Watertown Plank Rd, 53226, Milwaukee, WI, USA

    Sergey Tarima PhD

  5. Division of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, 3333 Burnet Ave, 45229, OH, USA

    Peter F. Sturm MD

Authors
  1. Karen M. Kruger PhD
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  2. Christina M. R. Garman PhD
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  3. Joseph J. Krzak PhD
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  4. Adam Graf MS
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  5. Sahar Hassani MS
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  6. Sergey Tarima PhD
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  7. Peter F. Sturm MD
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  8. Kim W. Hammerberg MD
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  9. Purnendu Gupta MD
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  10. Gerald F. Harris
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Corresponding author

Correspondence to Karen M. Kruger PhD.

Additional information

Author disclosures: KMK (grants from the US Department of Health and Human Services [USDHHS]–National Institute on Disability, Independent Living, and Rehabilitation Research [NIDILRR], during the conduct of the study), CMRG (grants from the USDHHS–NIDILRR, during the conduct of the study), JJK (grants from Hainer Foundation, DePuy Spine, and the USDHHS–NIDILRR, during the conduct of the study), AG (grants from Hainer Foundation, DePuy Spine, and the USDHHS–NIDILRR, during the conduct of the study), SH (grants from Hainer Foundation and DePuy Spine, during the conduct of the study), ST (none), PFS (personal fees from Ellipse Technologies, Medtronic, DePuy Spine, and Biomet, during the conduct of the study), KWH (grants from Hainer Foundation and DePuy Spine, during the conduct of the study), PG (grants from Hainer Foundation and DePuy Spine, during the conduct of the study), GFH (grants from USDHHS–NIDILRR, Hainer Foundation, and DePuy, during the conduct of the study).

IRB approval: All participants freely consented in accordance with an institutionally approved IRB protocol.

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Kruger, K.M., Garman, C.M.R., Krzak, J.J. et al. Effects of Spinal Fusion for Idiopathic Scoliosis on Lower Body Kinematics During Gait. Spine Deform 6, 441–447 (2018). https://doi.org/10.1016/j.jspd.2017.12.008

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  • DOI: https://doi.org/10.1016/j.jspd.2017.12.008

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