Skip to main content
SpringerLink
Log in

Alterations of gait kinematics depend on the deformity type in the setting of adult spinal deformity

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

Abstract

Purpose

To evaluate 3D kinematic alterations during gait in Adult Spinal Deformity (ASD) subjects with different deformity presentations.

Methods

One hundred nineteen primary ASD (51 ± 19y, 90F), age and sex-matched to 60 controls, underwent 3D gait analysis with subsequent calculation of 3D lower limb, trunk and segmental spine kinematics as well as the gait deviation index (GDI). ASD were classified into three groups: 51 with sagittal malalignment (ASD-Sag: SVA > 50 mm, PT > 25°, and/or PI-LL > 10°), 28 with only frontal deformity (ASD-Front: Cobb > 20°) and 40 with only hyperkyphosis (ASD-HyperTK: TK > 60°). Kinematics were compared between groups.

Results

ASD-Sag had a decreased pelvic mobility compared to controls with a decreased ROM of hips (38 vs. 45°) and knees (51 vs. 61°). Furthermore, ASD-Sag exhibited a decreased walking speed (0.8 vs. 1.2 m/s) and GDI (80 vs. 95, all p < 0.05) making them more prone to falls. ASD-HyperTK showed similar patterns but in a less pronounced way. ASD-Front had normal walking patterns. GDI, knee flex/extension and walking speed were significantly associated with SVA and PT (r = 0.30–0.65).

Conclusion

Sagittal spinal malalignment seems to be the driver of gait alterations in ASD. Patients with higher GT, SVA, PT or PI-LL tended to walk slower, with shorter steps in order to maintain stability with a limited flexibility in the pelvis, hips and knees. These changes were found to a lesser extent in ASD with only hyperkyphosis but not in those with only frontal deformity. 3D gait analysis is an objective tool to evaluate functionality in ASD patients depending on their type of spinal deformity.

Level of evidence I

Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

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

Similar content being viewed by others

References

  1. United Nations, Department of Economic and Social Affairs PD (2017) World population ageing 2017–Highlights (ST/ESA/SER.A/397).

  2. Fehlings MG, Tetreault L, Nater A et al (2015) The aging of the global population: the changing epidemiology of disease and spinal disorders. Neurosurgery 77:S1–S5. https://doi.org/10.1227/NEU.0000000000000953

    Article  PubMed  Google Scholar 

  3. 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 

  4. Acaroğlu RE, Dede Ö, Pellisé F et al (2016) Adult spinal deformity: a very heterogeneous population of patients with different needs. Acta Orthop Traumatol Turc 50:57–62. https://doi.org/10.3944/AOTT.2016.14.0421

    Article  PubMed  Google Scholar 

  5. Lafage R, Schwab F, Challier V et al (2016) Defining spino-pelvic alignment thresholds. Spine 41:62–68. https://doi.org/10.1097/BRS.0000000000001171

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  7. Schwab F, Dubey A, Pagala M et al (2003) Adult scoliosis: a health assessment analysis by SF-36. Spine 28:602–606. https://doi.org/10.1097/01.BRS.0000049924.94414.BB

    Article  PubMed  Google Scholar 

  8. Bess S, Line B, Fu K-M et al (2016) The health impact of symptomatic adult spinal deformity: comparison of deformity types to united states population norms and chronic diseases. Spine 41:224–233. https://doi.org/10.1097/BRS.0000000000001202

    Article  PubMed  PubMed Central  Google Scholar 

  9. Fujishiro T, Boissière L, Cawley DT et al (2018) Decision-making factors in the treatment of adult spinal deformity. Eur Spine J. https://doi.org/10.1007/s00586-018-5572-6

    Article  PubMed  Google Scholar 

  10. Fujishiro T, Boissière L, Cawley DT et al (2020) Clinical performance and concurrent validity of the adult spinal deformity surgical decision-making score. Spine 45:E847–E855. https://doi.org/10.1097/BRS.0000000000003434

    Article  PubMed  Google Scholar 

  11. Dubousset J (1994) Three-dimensional analysis of the scoliotic deformity. Pediatr Spine 1994:479–496

    Google Scholar 

  12. Lafage V, Schwab F, Skalli W et al (2008) Standing balance and sagittal plane spinal deformity: analysis of spinopelvic and gravity line parameters. Spine 33:1572–1578. https://doi.org/10.1097/BRS.0b013e31817886a2

    Article  PubMed  Google Scholar 

  13. Pellisé F, Serra-Burriel M, Vila-Casademunt A et al (2021) Quality metrics in adult spinal deformity surgery over the last decade: a combined analysis of the largest prospective multicenter data sets. J Neurosurg Spine 36:226–234. https://doi.org/10.3171/2021.3.SPINE202140

    Article  Google Scholar 

  14. Pau M, Corona F, Pili R et al (2016) Effects of physical rehabilitation integrated with rhythmic auditory stimulation on Spatio-temporal and kinematic parameters of gait in Parkinson’s disease. Front Neurol 7:126. https://doi.org/10.3389/fneur.2016.00126

    Article  PubMed  PubMed Central  Google Scholar 

  15. Davids JR (2006) Quantitative gait analysis in the treatment of children with cerebral palsy. J Pediatr Orthop 26:557–559. https://doi.org/10.1097/01.bpo.0000226284.46943.a3

    Article  PubMed  Google Scholar 

  16. Sangeux MSA (2015) Kinematic deviation in children with cerebral palsy. Orthop Manag Child Cereb Palsy

  17. Kawkabani G, Saliby RM, Mekhael M et al (2021) Gait kinematic alterations in subjects with adult spinal deformity and their radiological determinants. Gait Posture 88:203–209. https://doi.org/10.1016/j.gaitpost.2021.06.003

    Article  PubMed  Google Scholar 

  18. Chaibi Y, Cresson T, Aubert B et al (2012) Fast 3D reconstruction of the lower limb using a parametric model and statistical inferences and clinical measurements calculation from biplanar X-rays. Comput Methods Biomech Biomed Engin 15:457–466. https://doi.org/10.1080/10255842.2010.540758

    Article  CAS  PubMed  Google Scholar 

  19. Yilgor C, Sogunmez N, Yavuz Y et al (2017) Relative lumbar lordosis and lordosis distribution index: individualized pelvic incidence–based proportional parameters that quantify lumbar lordosis more precisely than the concept of pelvic incidence minus lumbar lordosis. Neurosurg Focus 43:1–9. https://doi.org/10.3171/2017.8.FOCUS17498

    Article  Google Scholar 

  20. Obeid I, Bourghli A, Larrieu D et al (2016) The global tilt: evaluation of a parameter considering the global spinopelvic alignment. J Med Liban 64:146–151. https://doi.org/10.12816/0031523

    Article  PubMed  Google Scholar 

  21. Yilgor C, Sogunmez N, Boissiere L et al (2017) Global alignment and proportion (gap) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. J Bone Jt Surg Am 99:1661–1672. https://doi.org/10.2106/JBJS.16.01594

    Article  Google Scholar 

  22. Iwai C, Pizones J, Boissière L et al (2021) Static and dynamic sagittal lumbar apex : a new concept for the assessment of lumbar lordosis distribution in spinal deformity. Eur Spine J. https://doi.org/10.1007/s00586-021-06767-7

    Article  PubMed  Google Scholar 

  23. Boissière L, Takemoto M, Bourghli A, Vital JM (2016) Global tilt and lumbar lordosis index : two parameters correlating with health-related quality of life scores–but how do they truly impact disability ? Spine J. https://doi.org/10.1016/j.spinee.2016.10.013

    Article  PubMed  Google Scholar 

  24. Davis RB, Õunpuu S, Tyburski D, Gage JR (1991) A gait analysis data collection and reduction technique. Hum Mov Sci 10:575–587. https://doi.org/10.1016/0167-9457(91)90046-Z

    Article  Google Scholar 

  25. Leardini A, Biagi F, Merlo A et al (2011) Multi-segment trunk kinematics during locomotion and elementary exercises. Clin Biomech 26:562–571. https://doi.org/10.1016/J.CLINBIOMECH.2011.01.015

    Article  Google Scholar 

  26. 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 

  27. Assi A, Ghanem I, Lavaste F, Skalli W (2009) Gait analysis in children and uncertainty assessment for davis protocol and gillette gait index. Gait Posture. https://doi.org/10.1016/j.gaitpost.2009.02.011

    Article  PubMed  Google Scholar 

  28. Benedetti M, Catani F, Leardini A et al (1998) Data management in gait analysis for clinical applications. Clin Biomech 13:204–215. https://doi.org/10.1016/S0268-0033(97)00041-7

    Article  CAS  Google Scholar 

  29. Yagi M, Kaneko S, Yato Y, Asazuma T (2017) Standing Balance and Compensatory Mechanisms in Patients with Adult Spinal Deformity. Spine 42:E584–E591. https://doi.org/10.1097/BRS.0000000000001901

    Article  PubMed  Google Scholar 

  30. Lafage V, Schwab F, Skalli W et al (2008) Standing balance and sagittal plane spinal deformity analysis of spinopelvic and gravity line parameters. Spine 33:1572–1578

    Article  PubMed  Google Scholar 

  31. Roussouly P, Pinheiro-Franco JL (2011) Sagittal parameters of the spine: biomechanical approach. Eur Spine J 20:578–585. https://doi.org/10.1007/s00586-011-1924-1

    Article  PubMed  PubMed Central  Google Scholar 

  32. 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. https://doi.org/10.1186/S12877-021-02192-Z

    Article  PubMed  PubMed Central  Google Scholar 

  33. Arima H, Yamato Y, Hasegawa T et al (2017) Discrepancy between standing posture and sagittal balance during walking in adult spinal deformity patients. Spine 42:E25–E30. https://doi.org/10.1097/BRS.0000000000001709

    Article  PubMed  Google Scholar 

  34. Severijns P, Moke L, Overbergh T et al (2021) Tag edH1 dynamic sagittal alignment and compensation strategies in adult spinal deformity during walking Tag edEn. Spine J 21:1059–1071. https://doi.org/10.1016/j.spinee.2021.02.017

    Article  PubMed  Google Scholar 

  35. Daniels AH, Smith JS, Hiratzka J et al (2015) Functional limitations due to lumbar stiffness in adults with and without spinal deformity. Spine 40:1599–1604. https://doi.org/10.1097/BRS.0000000000001090

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This research was funded by the University of Saint-Joseph (grant FM361), EUROSPINE (TFR2020#22) and CNRS-L. 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

Author notes

  1. Rami Rachkidi and Eddy Saad have contributed equally.

Authors and Affiliations

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

    Karl Semaan, Rami Rachkidi, Eddy Saad, Abir Massaad, Georges Kawkabani, Renée Maria Saliby, Mario Mekhael, Krystel Abi Karam, Marc Fakhoury, Elena Jaber, Ismat Ghanem & Ayman Assi

  2. Institut de Biomécanique Humaine Georges Charpak, Arts Et Métiers, Paris, France

    Wafa Skalli & Ayman Assi

  3. Lenox Hill Hospital, New York, USA

    Virginie Lafage

Authors
  1. Karl Semaan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rami Rachkidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eddy Saad
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abir Massaad
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Georges Kawkabani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Renée Maria Saliby
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mario Mekhael
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Krystel Abi Karam
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Marc Fakhoury
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Elena Jaber
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ismat Ghanem
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Wafa Skalli
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Virginie Lafage
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. 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

None.

Additional information

Publisher's Note

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

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Semaan, K., Rachkidi, R., Saad, E. et al. Alterations of gait kinematics depend on the deformity type in the setting of adult spinal deformity. Eur Spine J 31, 3069–3080 (2022). https://doi.org/10.1007/s00586-022-07348-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-022-07348-y

Keywords

Search

Navigation