Advertisement

European Spine Journal

, Volume 22, Issue 6, pp 1354–1361 | Cite as

Determination of the amount of leg length inequality that alters spinal posture in healthy subjects using rasterstereography

  • Marcel BetschEmail author
  • Walter Rapp
  • Anna Przibylla
  • Pascal Jungbluth
  • Mohssen Hakimi
  • Johannes Schneppendahl
  • Simon Thelen
  • Michael Wild
Original Article

Abstract

Purpose

Leg length inequalities (LLIs) can result in an increased energy consumption, abnormal gait or osteoarthritis of the hip. In a previous study we simulated different LLIs of up to 15 mm and evaluated their effects on the pelvic position and spinal posture. We found a correlation between LLIs and resulting changes of the pelvic position. Despite suggestions in the literature we were not able to detect significant changes of the spinal posture. Therefore, the purpose of this study was to determine the amount of LLI that would in fact alter the spinal posture.

Methods

The subjects were placed on a simulation platform, whose height could be precisely controlled by the measuring device, to simulate different LLIs of up to 20 mm. For LLIs >20 mm, additional precision-cut wooden blocks were used under one foot. After an adaptation period the resulting changes of the pelvis and spine were measured with a rasterstereographic device.

Results

We found a significant correlation between platform height changes and changes of the pelvic position. The frontal spinal parameters surface rotation and lateral deviation changed significantly when simulating differences greater than 20 mm. No changes of the sagittal spinal curvature were measured, however, a trend to decreasing kyphotic angles was noted.

Conclusions

Our study has shown for the first time that LLIs >20 mm will lead to significant changes in the spinal posture of healthy test subjects. However, these changes were only found in frontal (surface rotation and lateral flexion) spinal parameters, but not in sagittal parameters. Here for the kyphotic angle only a tendency to decreasing angles was noted. We have also found a significant correlation between different leg lengths and changes of the pelvic position. Further, females and males seem to react in the same way to LLIs.

Keywords

Leg length inequalities Rasterstereography Posture Pelvic obliquity Functional scoliosis 

Notes

Acknowledgments

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Conflict of interest

None.

References

  1. 1.
    Perttunen JR, Anttila E, Sodergard J, Merikanto J, Komi PV (2004) Gait asymmetry in patients with limb length discrepancy. Scand J Med Sci Sports 14(1):49–56PubMedCrossRefGoogle Scholar
  2. 2.
    Friberg O (1983) Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality. Spine (Phila Pa 1976) 8(6):643–651CrossRefGoogle Scholar
  3. 3.
    Giles LG, Taylor JR (1982) Lumbar spine structural changes associated with leg length inequality. Spine (Phila Pa 1976) 7(2):159–162CrossRefGoogle Scholar
  4. 4.
    Papaioannou T, Stokes I, Kenwright J (1982) Scoliosis associated with limb-length inequality. J Bone Joint Surg Am 64(1):59–62PubMedGoogle Scholar
  5. 5.
    Betsch M, Wild M, Grosse B, Rapp W, Horstmann T (2011) The effect of simulating leg length inequality on spinal posture and pelvic position: a dynamic rasterstereographic analysis. Eur Spine J 21(4):691–697. doi: 10.1007/s00586-011-1912-5 PubMedCrossRefGoogle Scholar
  6. 6.
    Drerup B, Hierholzer E (1987) Movement of the human pelvis and displacement of related anatomical landmarks on the body surface. J Biomech 20(10):971–977PubMedCrossRefGoogle Scholar
  7. 7.
    Drerup B, Hierholzer E (1987) Automatic localization of anatomical landmarks on the back surface and construction of a body-fixed coordinate system. J Biomech 20(10):961–970PubMedCrossRefGoogle Scholar
  8. 8.
    Beaudoin L, Zabjek KF, Leroux MA, Coillard C, Rivard CH (1999) Acute systematic and variable postural adaptations induced by an orthopaedic shoe lift in control subjects. Eur Spine J 8(1):40–45PubMedCrossRefGoogle Scholar
  9. 9.
    Langer S (1976) Structural leg shortage. A case report. J Am Podiatry Assoc 66(1):38–40PubMedGoogle Scholar
  10. 10.
    Blustein SM, D’Amico JC (1985) Limb length discrepancy. Identification, clinical significance, and management. J Am Podiatr Med Assoc 75(4):200–206PubMedGoogle Scholar
  11. 11.
    Betsch M, Wild M, Jungbluth P, Hakimi M, Windolf J, Haex B, Horstmann T, Rapp W (2011) Reliability and validity of 4D rasterstereography under dynamic conditions. Comput Biol Med 41(6):308–312. doi: 10.1016/j.compbiomed.2011.03.008 PubMedCrossRefGoogle Scholar
  12. 12.
    Hackenberg L, Hierholzer E, Liljenqvist U (2002) Accuracy of rasterstereography versus radiography in idiopathic scoliosis after anterior correction and fusion. Stud Health Technol Inform 91:241–245PubMedGoogle Scholar
  13. 13.
    Hackenberg L, Liljenqvist U, Hierholzer E, Halm H (2000) Scanning stereographic surface measurement in idiopathic scoliosis after VDS (ventral derotation spondylodesis). Z Orthop Ihre Grenzgeb 138(4):353–359. doi: 10.1055/s-2000-10162 PubMedCrossRefGoogle Scholar
  14. 14.
    Goh SPR, Leedman PJ, Singer KP (1999) Rasterstereographic analysis of the thoracic sagittal curvature: a reliability study. J Muscoskel Res 3(2):137–142CrossRefGoogle Scholar
  15. 15.
    Crawford RJ, Price RI, Singer KP (2009) The effect of interspinous implant surgery on back surface shape and radiographic lumbar curvature. Clin Biomech (Bristol, Avon) 24(6):467–472. doi: 10.1016/j.clinbiomech.2009.04.003 CrossRefGoogle Scholar
  16. 16.
    Goh S, Price RI, Leedman PJ, Singer KP (2000) A comparison of three methods for measuring thoracic kyphosis: implications for clinical studies. Rheumatology (Oxford) 39(3):310–315CrossRefGoogle Scholar
  17. 17.
    Drerup B, Ellger B, Hierholzer E, Meyer zu Bentrup FM (2001) Functional rasterstereographic images. A new method for biomechanical analysis of skeletal geometry. Orthopade 30(4):242–250PubMedCrossRefGoogle Scholar
  18. 18.
    Froh R, Yong-Hing K, Cassidy JD, Houston CS (1988) The relationship between leg length discrepancy and lumbar facet orientation. Spine (Phila Pa 1976) 13(3):325–327CrossRefGoogle Scholar
  19. 19.
    Knutson GA (2005) Anatomic and functional leg-length inequality: a review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance. Chiropr Osteopat 13:11PubMedCrossRefGoogle Scholar
  20. 20.
    ten Brinke A, van der Aa HE, van der Palen J, Oosterveld F (1999) Is leg length discrepancy associated with the side of radiating pain in patients with a lumbar herniated disc? Spine (Phila Pa 1976) 24(7):684–686CrossRefGoogle Scholar
  21. 21.
    Young RS, Andrew PD, Cummings GS (2000) Effect of simulating leg length inequality on pelvic torsion and trunk mobility. Gait Posture 11(3):217–223PubMedCrossRefGoogle Scholar
  22. 22.
    Janssen MM, Drevelle X, Humbert L, Skalli W, Castelein RM (2009) Differences in male and female spino-pelvic alignment in asymptomatic young adults: a three-dimensional analysis using upright low-dose digital biplanar X-rays. Spine (Phila Pa 1976) 34(23):E826–E832. doi: 10.1097/BRS.0b013e3181a9fd85 CrossRefGoogle Scholar
  23. 23.
    Jones KB, Sponseller PD, Hobbs W, Pyeritz RE (2002) Leg-length discrepancy and scoliosis in Marfan syndrome. J Pediatr Orthop 22(6):807–812PubMedGoogle Scholar
  24. 24.
    Irvin RE (1991) Reduction of lumbar scoliosis by use of a heel lift to level the sacral base. J Am Osteopath Assoc 91(1):34, 37–44Google Scholar
  25. 25.
    Frayer DW, Lozano M, Bermudez de Castro JM, Carbonell E, Arsuaga JL, Radovcic J, Fiore I, Bondioli L More than 500,000 years of right-handedness in Europe. Laterality 1–19. doi:  10.1080/1357650X.2010.529451
  26. 26.
    DeVita P, Hong D, Hamill J (1991) Effects of asymmetric load carrying on the biomechanics of walking. J Biomech 24(12):1119–1129PubMedCrossRefGoogle Scholar
  27. 27.
    Hesse S, Reiter F, Jahnke M, Dawson M, Sarkodie-Gyan T, Mauritz KH (1997) Asymmetry of gait initiation in hemiparetic stroke subjects. Arch Phys Med Rehabil 78(7):719–724PubMedCrossRefGoogle Scholar
  28. 28.
    Lang-Tapia M, Espana-Romero V, Anelo J, Castillo MJ (2011) Differences on spinal curvature in standing position by gender, age and weight status using a noninvasive method. J Appl Biomech 27(2):143–150PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Marcel Betsch
    • 1
    • 4
    Email author
  • Walter Rapp
    • 2
  • Anna Przibylla
    • 1
  • Pascal Jungbluth
    • 1
  • Mohssen Hakimi
    • 1
  • Johannes Schneppendahl
    • 1
  • Simon Thelen
    • 1
  • Michael Wild
    • 3
  1. 1.Department of Trauma and Hand SurgeryUniversity Hospital DuesseldorfDuesseldorfGermany
  2. 2.Department of Sports MedicineUniversity Hospital TuebingenTuebingenGermany
  3. 3.Department of Trauma and Orthopaedic SurgeryKlinikum DarmstadtDarmstadtGermany
  4. 4.Department of Orthopaedics and RehabilitationOregon Health and Science UniversityPortlandUSA

Personalised recommendations