Skip to main content
SpringerLink
Log in

Assessment of dynamic balance during walking in patients with adult spinal deformity

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

Abstract

Purpose

To assess dynamic postural alignment in ASD during walking using a subject-specific 3D approach.

Methods

69 ASD (51 ± 20 years, 77%F) and 62 controls (34 ± 13 years, 62%F) underwent gait analysis along with full-body biplanar Xrays and filled HRQoL questionnaires. Spinopelvic and postural parameters were computed from 3D skeletal reconstructions, including radiographic odontoid to hip axis angle (ODHA) that evaluates the head’s position over the pelvis (rODHA), in addition to rSVA and rPT. The 3D bones were then registered on each gait frame to compute the dynamic ODHA (dODHA), dSVA, and dPT. Patients with high dODHA (> mean + 1SD in controls) were classified as ASD-DU (dynamically unbalanced), otherwise as ASD-DB (dynamically balanced). Between-group comparisons and relationship between parameters were investigated.

Results

26 patients were classified as ASD-DU having an average dODHA of 10.4° (ASD-DB: 1.2°, controls: 1.7°), dSVA of 112 mm (ASD-DB: 57 mm, controls: 43 mm), and dPT of 21° (ASD-DB: 18°, controls: 14°; all p < 0.001). On static radiographs, ASD-DU group showed more severe sagittal malalignment than ASD-DB, with more altered HRQoL outcomes. The ASD-DU group had an overall abnormal walking compared to ASD-DB & controls (gait deviation index: 81 versus 93 & 97 resp., p < 0.001) showing a reduced flexion/extension range of motion at the hips and knees with a slower gait speed and shorter step length. Dynamic ODHA was correlated to HRQoL scores.

Conclusion

Dynamically unbalanced ASD had postural malalignment that persist during walking, associated with kinematic alterations in the trunk, pelvis, and lower limbs, making them more prone to falls. Dynamic-ODHA correlates better with HRQoL outcomes than dSVA and dPT.

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

Access this article

Log in via an institution

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

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

References

  1. United Nations, Department of Economic and Social Affairs, Population Division (2017) World population ageing: 2017 highlights

  2. Schwab F, Dubey A, Gamez L et al (2005) Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine 30:1082–1085. https://doi.org/10.1097/01.brs.0000160842.43482.cd

    Article  PubMed  Google Scholar 

  3. Diebo BG, Shah NV, Boachie-Adjei O et al (2019) Adult spinal deformity. Lancet. https://doi.org/10.1016/S0140-6736(19)31125-0

    Article  PubMed  Google Scholar 

  4. Scheer JK, Lau D, Smith JS et al (2021) Alignment, classification, clinical evaluation, and surgical treatment for adult cervical deformity: a complete guide. Neurosurgery. https://doi.org/10.1093/neuros/nyaa582

    Article  PubMed  Google Scholar 

  5. Attali V, Clavel L, Rouch P et al (2019) Compensation of respiratory-related postural perturbation is achieved by maintenance of head-to-pelvis alignment in healthy humans. Front Physiol. https://doi.org/10.3389/fphys.2019.00441

    Article  PubMed  PubMed Central  Google Scholar 

  6. Schwab F, Ungar B, Blondel B et al (2012) Scoliosis research society—schwab adult spinal deformity classification. Spine. https://doi.org/10.1097/BRS.0b013e31823e15e2

    Article  PubMed  Google Scholar 

  7. Yagi M, Kaneko S, Yato Y, Asazuma T (2017) Standing balance and compensatory mechanisms in patients with adult spinal deformity. Spine. https://doi.org/10.1097/BRS.0000000000001901

    Article  PubMed  Google Scholar 

  8. Ferrero E, Guigui P, Khalifé M et al (2021) Global alignment taking into account the cervical spine with odontoid hip axis angle (OD-HA). Eur Spine J. https://doi.org/10.1007/s00586-021-06991-1

    Article  PubMed  Google Scholar 

  9. Haddas R, Ju KL, Belanger T, Lieberman IH (2018) The use of gait analysis in the assessment of patients afflicted with spinal disorders. Eur Spine J. https://doi.org/10.1007/s00586-018-5569-1

    Article  PubMed  Google Scholar 

  10. Severijns P, Moke L, Overbergh T et al (2021) Dynamic sagittal alignment and compensation strategies in adult spinal deformity during walking. Spine J 21:1059–1071. https://doi.org/10.1016/j.spinee.2021.02.017

    Article  PubMed  Google Scholar 

  11. Kawkabani G, Saliby RM, Mekhael M et al (2021) Gait kinematic alterations in subjects with adult spinal deformity and their radiological determinants. Gait Posture. https://doi.org/10.1016/j.gaitpost.2021.06.003

    Article  PubMed  Google Scholar 

  12. Miura K, Kadone H, Koda M et al (2020) 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. https://doi.org/10.1007/s00586-020-06312-y

    Article  PubMed  Google Scholar 

  13. Davis RB, Õunpuu S, Tyburski D, Gage JR (1991) A gait analysis data collection and reduction technique. Hum Mov Sci. https://doi.org/10.1016/0167-9457(91)90046-Z

    Article  Google Scholar 

  14. Leardini A, Biagi F, Merlo A et al (2011) Multi-segment trunk kinematics during locomotion and elementary exercises. Clin Biomech. https://doi.org/10.1016/j.clinbiomech.2011.01.015

    Article  Google Scholar 

  15. Schwartz MH, Rozumalski A (2008) The gait deviation index: a new comprehensive index of gait pathology. Gait Posture 28:351–357. https://doi.org/10.1016/j.gaitpost.2008.05.001

    Article  PubMed  Google Scholar 

  16. Kolta S, Etcheto A, Fechtenbaum J et al (2019) Measurement of trabecular bone score of the spine by low-dose imaging system (EOS®): a feasibility study. J Clin Densitom. https://doi.org/10.1016/j.jocd.2018.05.040

    Article  PubMed  Google Scholar 

  17. Kolta S, Quiligotti S, Ruyssen-Witrand A et al (2008) In vivo 3D reconstruction of human vertebrae with the three-dimensional X-ray absorptiometry (3D-XA) method. Osteoporos Int. https://doi.org/10.1007/s00198-007-0447-4

    Article  PubMed  Google Scholar 

  18. Lahkar BK, Rohan P-Y, Assi A et al (2021) Development and evaluation of a new methodology for soft tissue Artifact compensation in the lower limb. J Biomech 122:110464. https://doi.org/10.1016/j.jbiomech.2021.110464

    Article  PubMed  Google Scholar 

  19. Söderkvist I, Wedin P-Å (1993) Determining the movements of the skeleton using well-configured markers. J Biomech 26:1473–1477. https://doi.org/10.1016/0021-9290(93)90098-Y

    Article  PubMed  Google Scholar 

  20. Yamagata M, Tateuchi H, Shimizu I et al (2021) The relation between kinematic synergy to stabilize the center of mass during walking and future fall risks: a 1-year longitudinal study. BMC Geriatr 21:240. https://doi.org/10.1186/s12877-021-02192-z

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

This research was funded by the University of Saint-Joseph (grant FM361), EUROSPINE (TFR2020#22), and ParisTech BiomecAM chair program on subject-specific musculoskeletal modeling (with the support of ParisTech and Yves Cotrel Foundations, Société Générale, Proteor and Covea). The funding sources did not intervene in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Author information

Authors and Affiliations

  1. Institut de Biomécanique Humaine Georges Charpak, Arts Et Métiers Institute of Technology, Paris, France

    Guillaume Rebeyrat, Wafa Skalli, Hélène Pillet & Ayman Assi

  2. Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon

    Rami Rachkidi, Abir Massaad, Joe Mehanna, Karl Semaan, Eddy Saad, Ismat Ghanem & Ayman Assi

Authors
  1. Guillaume Rebeyrat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wafa Skalli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rami Rachkidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hélène Pillet
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Abir Massaad
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joe Mehanna
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Karl Semaan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Eddy Saad
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ismat Ghanem
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ayman Assi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ayman Assi.

Ethics declarations

Conflict of interest

Wafa Skalli holds patents related to the EOS system and associated 3D reconstruction methods, with no personal financial benefit (royalties rewarded for research and education). The other 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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rebeyrat, G., Skalli, W., Rachkidi, R. et al. Assessment of dynamic balance during walking in patients with adult spinal deformity. Eur Spine J 31, 1736–1744 (2022). https://doi.org/10.1007/s00586-022-07199-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-022-07199-7

Keywords

Search

Navigation