https://sam.ensam.eu:443 The DSpace digital repository system captures, stores, indexes, preserves, and distributes digital research material. Thu, 12 Mar 2026 22:35:17 GMT 2026-03-12T22:35:17Z http://hdl.handle.net/10985/18876 Influence of Spino-Pelvic and Postural Alignment Parameters on Gait Kinematics OTAYEK, Joeffroy; BIZDIKIAN, Aren Joe; YARED, Fares; SAAD, Eddy; BAKOUNY, Ziad; MASSAAD, Abir; GHANIMEH, Joe; LABAKI, Chris; SKALLI, Wafa; ISMAT, Ghanem; KREICHATI, Gaby; ASSI, Ayman Introduction: Postural alignment is altered with spine deformities that might occur with age. Alteration of spino-pelvic and postural alignment parameters are known to affect daily life activities such as gait. It is still unknown how spino-pelvic and postural alignment parameters are related to gait kinematics. Research question: To assess the relationships between spino-pelvic/postural alignment parameters and gait kinematics in asymptomatic adults. Methods: 134 asymptomatic subjects (aged 18-59 years) underwent 3D gait analysis, from which kinematics of the pelvis and lower limbs were extracted in the 3 planes. Subjects then underwent full-body biplanar X-rays, from which skeletal 3D reconstructions and spino-pelvic and postural alignment parameters were obtained such as sagittal vertical axis (SVA), center of auditory meatus to hip axis plumbline (CAM-HA), thoracic kyphosis (TK) and radiologic pelvic tilt (rPT). In order to assess the influence of spino-pelvic and postural alignment parameters on gait kinematics a univariate followed by a multivariate analysis were performed. Results: SVA was related to knee flexion during loading response (β = 0.268); CAM-HA to ROM pelvic obliquity (β = -0.19); rPT to mean pelvic tilt (β = -0.185) and ROM pelvic obliquity (β = -0.297); TK to ROM hip flexion/extension in stance (β = -0.17), mean foot progression in stance (β = -0.329), walking speed (β = -0.19), foot off (β = 0.223) and step length (β = -0.181). Significance: This study showed that increasing SVA, CAM-HA, TK and rPT, which is known to occur in adults with spinal deformities, could alter gait kinematics. Increases in these parameters, even in asymptomatic subjects, were related to a retroverted pelvis during gait, a reduced pelvic obliquity and hip flexion/extension mobility, an increased knee flexion during loading response as well as an increase in external foot progression angle. This was associated with a decrease in the walking pace: reduced speed, step length and longer stance phase. Wed, 01 Jan 2020 00:00:00 GMT http://hdl.handle.net/10985/18876 2020-01-01T00:00:00Z OTAYEK, Joeffroy BIZDIKIAN, Aren Joe YARED, Fares SAAD, Eddy BAKOUNY, Ziad MASSAAD, Abir GHANIMEH, Joe LABAKI, Chris SKALLI, Wafa ISMAT, Ghanem KREICHATI, Gaby ASSI, Ayman Introduction: Postural alignment is altered with spine deformities that might occur with age. Alteration of spino-pelvic and postural alignment parameters are known to affect daily life activities such as gait. It is still unknown how spino-pelvic and postural alignment parameters are related to gait kinematics. Research question: To assess the relationships between spino-pelvic/postural alignment parameters and gait kinematics in asymptomatic adults. Methods: 134 asymptomatic subjects (aged 18-59 years) underwent 3D gait analysis, from which kinematics of the pelvis and lower limbs were extracted in the 3 planes. Subjects then underwent full-body biplanar X-rays, from which skeletal 3D reconstructions and spino-pelvic and postural alignment parameters were obtained such as sagittal vertical axis (SVA), center of auditory meatus to hip axis plumbline (CAM-HA), thoracic kyphosis (TK) and radiologic pelvic tilt (rPT). In order to assess the influence of spino-pelvic and postural alignment parameters on gait kinematics a univariate followed by a multivariate analysis were performed. Results: SVA was related to knee flexion during loading response (β = 0.268); CAM-HA to ROM pelvic obliquity (β = -0.19); rPT to mean pelvic tilt (β = -0.185) and ROM pelvic obliquity (β = -0.297); TK to ROM hip flexion/extension in stance (β = -0.17), mean foot progression in stance (β = -0.329), walking speed (β = -0.19), foot off (β = 0.223) and step length (β = -0.181). Significance: This study showed that increasing SVA, CAM-HA, TK and rPT, which is known to occur in adults with spinal deformities, could alter gait kinematics. Increases in these parameters, even in asymptomatic subjects, were related to a retroverted pelvis during gait, a reduced pelvic obliquity and hip flexion/extension mobility, an increased knee flexion during loading response as well as an increase in external foot progression angle. This was associated with a decrease in the walking pace: reduced speed, step length and longer stance phase. http://hdl.handle.net/10985/21495 Alteration of the sitting and standing movement in adult spinal deformity SAAD, Eddy; SEMAAN, Karl; KAWKABANI, Georges; MASSAAD, Abir; SALIBY, Renée Maria; MEKHAEL, Mario; FAKHOURY, Marc; KARAM, Krystel Abi; JABER, Elena; GHANEM, Ismat; LAFAGE, Virginie; SKALLI, Wafa; RACHKIDI, Rami; ASSI, Ayman Adults with spinal deformity (ASD) are known to have spinal malalignment affecting their quality of life and daily life activities. While walking kinematics were shown to be altered in ASD, other functional activities are yet to be evaluated such as sitting and standing, which are essential for patients’ autonomy and quality of life perception. In this cross-sectional study, 93 ASD subjects (50 ± 20 years; 71 F) age and sex matched to 31 controls (45 ± 15 years; 18 F) underwent biplanar radiographic imaging with subsequent calculation of standing radiographic spinopelvic parameters. All subjects filled HRQOL questionnaires such as SF36 and ODI. ASD were further divided into 34 ASD-sag (with PT > 25° and/or SVA >5 cm and/or PI-LL >10°), 32 ASD-hyperTK (with only TK >60°), and 27 ASD-front (with only frontal malalignment: Cobb >20°). All subjects underwent 3D motion analysis during the sit-to-stand and stand-to-sit movements. The range of motion (ROM) and mean values of pelvis, lower limbs, thorax, head, and spinal segments were calculated on the kinematic waveforms. Kinematics were compared between groups and correlations to radiographic and HRQOL scores were computed. During sit-to-stand and stand-to-sit movements, ASD-sag had decreased pelvic anteversion (12.2 vs 15.2°), hip flexion (53.0 vs 62.2°), sagittal mobility in knees (87.1 vs 93.9°), and lumbar mobility (L1L3-L3L5: −9.1 vs −6.8°, all p < 0.05) compared with controls. ASD-hyperTK showed increased dynamic lordosis (L1L3–L3L5: −9.1 vs −6.8°), segmental thoracic kyphosis (T2T10–T10L1: 32.0 vs 17.2°, C7T2–T2T10: 30.4 vs 17.7°), and thoracolumbar extension (T10L1–L1L3: −12.4 vs −5.5°, all p < 0.05) compared with controls. They also had increased mobility at the thoracolumbar and upper-thoracic spine. Both ASD-sag and ASD-hyperTK maintained a flexed trunk, an extended head along with an increased trunk and head sagittal ROM. Kinematic alterations were correlated to radiographic parameters and HRQOL scores. Even after controlling for demographic factors, dynamic trunk flexion was determined by TK and PI-LL mismatch (adj. R² = 0.44). Lumbar sagittal ROM was determined by PI-LL mismatch (adj. R² = 0.13). In conclusion, the type of spinal deformity in ASD seems to determine the strategy used for sitting and standing. Future studies should evaluate whether surgical correction of the deformity could restore sitting and standing kinematics and ultimately improve quality of life. Sat, 01 Jan 2022 00:00:00 GMT http://hdl.handle.net/10985/21495 2022-01-01T00:00:00Z SAAD, Eddy SEMAAN, Karl KAWKABANI, Georges MASSAAD, Abir SALIBY, Renée Maria MEKHAEL, Mario FAKHOURY, Marc KARAM, Krystel Abi JABER, Elena GHANEM, Ismat LAFAGE, Virginie SKALLI, Wafa RACHKIDI, Rami ASSI, Ayman Adults with spinal deformity (ASD) are known to have spinal malalignment affecting their quality of life and daily life activities. While walking kinematics were shown to be altered in ASD, other functional activities are yet to be evaluated such as sitting and standing, which are essential for patients’ autonomy and quality of life perception. In this cross-sectional study, 93 ASD subjects (50 ± 20 years; 71 F) age and sex matched to 31 controls (45 ± 15 years; 18 F) underwent biplanar radiographic imaging with subsequent calculation of standing radiographic spinopelvic parameters. All subjects filled HRQOL questionnaires such as SF36 and ODI. ASD were further divided into 34 ASD-sag (with PT > 25° and/or SVA >5 cm and/or PI-LL >10°), 32 ASD-hyperTK (with only TK >60°), and 27 ASD-front (with only frontal malalignment: Cobb >20°). All subjects underwent 3D motion analysis during the sit-to-stand and stand-to-sit movements. The range of motion (ROM) and mean values of pelvis, lower limbs, thorax, head, and spinal segments were calculated on the kinematic waveforms. Kinematics were compared between groups and correlations to radiographic and HRQOL scores were computed. During sit-to-stand and stand-to-sit movements, ASD-sag had decreased pelvic anteversion (12.2 vs 15.2°), hip flexion (53.0 vs 62.2°), sagittal mobility in knees (87.1 vs 93.9°), and lumbar mobility (L1L3-L3L5: −9.1 vs −6.8°, all p < 0.05) compared with controls. ASD-hyperTK showed increased dynamic lordosis (L1L3–L3L5: −9.1 vs −6.8°), segmental thoracic kyphosis (T2T10–T10L1: 32.0 vs 17.2°, C7T2–T2T10: 30.4 vs 17.7°), and thoracolumbar extension (T10L1–L1L3: −12.4 vs −5.5°, all p < 0.05) compared with controls. They also had increased mobility at the thoracolumbar and upper-thoracic spine. Both ASD-sag and ASD-hyperTK maintained a flexed trunk, an extended head along with an increased trunk and head sagittal ROM. Kinematic alterations were correlated to radiographic parameters and HRQOL scores. Even after controlling for demographic factors, dynamic trunk flexion was determined by TK and PI-LL mismatch (adj. R² = 0.44). Lumbar sagittal ROM was determined by PI-LL mismatch (adj. R² = 0.13). In conclusion, the type of spinal deformity in ASD seems to determine the strategy used for sitting and standing. Future studies should evaluate whether surgical correction of the deformity could restore sitting and standing kinematics and ultimately improve quality of life. http://hdl.handle.net/10985/24041 ASD with high pelvic retroversion develop changes in their acetabular orientation during walking ASSI, Ayman; REBEYRAT, Guillaume; EL RACHKIDI, Rami; SEMAAN, Karl; SAAD, Eddy; MEKHAEL, Elio; NASSIM, Nabil; MASSAAD, Abir; LAFAGE, Virginie; GHANEM, Ismat; PILLET, Helene; SKALLI, Wafa Introduction: It was hypothesized that pelvic retroversion in Adult Spinal Deformity (ASD) can be related to an increased hip loading explaining the occurrence of hip-spine syndrome. Research question: How pelvic retroversion can modify acetabular orientation in ASD during walking? Methods: 89 primary ASD and 37 controls underwent 3D gait analysis and full-body biplanar X-rays. Classic spinopelvic parameters were calculated from 3D skeletal reconstructions in addition to acetabular anteversion, abduction, tilt, and coverage. Then, 3D bones were registered on each gait frame to compute the dynamic value of the radiographic parameters during walking. ASD patients having a high PT were grouped as ASD-highPT, otherwise as ASD-normPT. Control group was divided in: C-aged and C-young, age matched to ASD-hightPT and ASD-normPT respectively. Results: 25/89 patients were classified as ASD-highPT having a radiographic PT of 31° (vs 12° in other groups, p ​< ​0.001). On static radiograph, ASD-highPT showed more severe postural malalignment than the other groups: ODHA ​= ​5°, L1L5 ​= ​17°, SVA ​= ​57.4 ​mm (vs 2°, 48° and 5 ​mm resp. in other groups,all p ​< ​0.001). During gait, ASD-highPT presented a higher dynamic pelvic retroversion of 30° (vs 15° in C-aged), along with a higher acetabular anteversion of 24° (vs 20°), external coverage of 38° (vs 29°) and a lower anterior coverage of 52° (vs 58°,all p ​< ​0.05). Conclusion: ASD patients with severe pelvic retroversion showed an increased acetabular anteversion, external coverage and lower anterior coverage during gait. These changes in acetabular orientation, computed during walking, were shown to be related to hip osteoarthritis. Mon, 01 May 2023 00:00:00 GMT http://hdl.handle.net/10985/24041 2023-05-01T00:00:00Z ASSI, Ayman REBEYRAT, Guillaume EL RACHKIDI, Rami SEMAAN, Karl SAAD, Eddy MEKHAEL, Elio NASSIM, Nabil MASSAAD, Abir LAFAGE, Virginie GHANEM, Ismat PILLET, Helene SKALLI, Wafa Introduction: It was hypothesized that pelvic retroversion in Adult Spinal Deformity (ASD) can be related to an increased hip loading explaining the occurrence of hip-spine syndrome. Research question: How pelvic retroversion can modify acetabular orientation in ASD during walking? Methods: 89 primary ASD and 37 controls underwent 3D gait analysis and full-body biplanar X-rays. Classic spinopelvic parameters were calculated from 3D skeletal reconstructions in addition to acetabular anteversion, abduction, tilt, and coverage. Then, 3D bones were registered on each gait frame to compute the dynamic value of the radiographic parameters during walking. ASD patients having a high PT were grouped as ASD-highPT, otherwise as ASD-normPT. Control group was divided in: C-aged and C-young, age matched to ASD-hightPT and ASD-normPT respectively. Results: 25/89 patients were classified as ASD-highPT having a radiographic PT of 31° (vs 12° in other groups, p ​< ​0.001). On static radiograph, ASD-highPT showed more severe postural malalignment than the other groups: ODHA ​= ​5°, L1L5 ​= ​17°, SVA ​= ​57.4 ​mm (vs 2°, 48° and 5 ​mm resp. in other groups,all p ​< ​0.001). During gait, ASD-highPT presented a higher dynamic pelvic retroversion of 30° (vs 15° in C-aged), along with a higher acetabular anteversion of 24° (vs 20°), external coverage of 38° (vs 29°) and a lower anterior coverage of 52° (vs 58°,all p ​< ​0.05). Conclusion: ASD patients with severe pelvic retroversion showed an increased acetabular anteversion, external coverage and lower anterior coverage during gait. These changes in acetabular orientation, computed during walking, were shown to be related to hip osteoarthritis. http://hdl.handle.net/10985/23243 Spinopelvic Adaptations in Standing and Sitting Positions in Patients With Adult Spinal Deformity EL RACHKIDI, Rami; MASSAAD, Abir; SAAD, Eddy; KAWKABANI, Georges; SEMAAN, Karl; ABI NAHED, Julien; GHANEM, Ismat; LAFAGE, Virginie; SKALLI, Wafa; ASSI, Ayman Purpose To describe spinopelvic adaptations in the standing and sitting positions in patients with adult spinal deformity (ASD). Methods Ninety-five patients with ASD and 32 controls completed health-related quality of life (HRQOL) questionnaires: short form 36 (SF36), Oswestry Disability Index (ODI), and visual analog scale (VAS) for pain. They underwent biplanar radiography in both standing and sitting positions. Patients with ASD were divided into ASD-front (frontal deformity Cobb > 20°, n = 24), ASD-sag (sagittal vertical axis (SVA) > 50 mm, pelvic tilt (PT) > 25°, or pelvic incidence (PI)-lumbar lordosis (LL) > 10°, n = 40), and ASD-hyper thoracic kyphosis (TK >60°, n = 31) groups. Flexibility was defined as the difference (Δ) in radiographic parameters between the standing and sitting positions. The radiographic parameters were compared between the groups. Correlations between HRQOL scores were evaluated. Results All participants increased their SVA from standing to sitting (ΔSVA<0), except for patients with ASD-sag, who tended to decrease their SVA (78-62 mm) and maximize their pelvic retroversion (27-40° vs 10-34° in controls, p<0.001). They also showed reduced thoracic and lumbar flexibility (ΔLL = 3.4 vs 37.1°; ΔTK = −1.7 vs 9.4° in controls, p<0.001). ASD-hyperTK showed a decreased PT while sitting (28.9 vs 34.4° in controls, p<0.001); they tended to decrease their LL and TK but could not reach values for controls (ΔLL = 22.8 vs 37.1° and ΔTK = 5.2 vs 9.4°, p<0.001). The ASD-front had normal standing and sitting postures. ΔSVA and ΔLL were negatively correlated with the physical component scale (PCS of SF36) and ODI (r = −0.39 and r = −0.46, respectively). Conclusion Patients with ASD present with different spinopelvic postures and adaptations from standing to sitting positions, with those having sagittal malalignment most affected. In addition, changes in standing and sitting postures were related to HRQOL outcomes. Therefore, surgeons should consider patient sitting adaptations in surgical planning and spinal fusion. Future studies on ASD should evaluate whether physical therapy or spinal surgery can improve sitting posture and QOL, especially for those with high SVA or PT. Mon, 01 Aug 2022 00:00:00 GMT http://hdl.handle.net/10985/23243 2022-08-01T00:00:00Z EL RACHKIDI, Rami MASSAAD, Abir SAAD, Eddy KAWKABANI, Georges SEMAAN, Karl ABI NAHED, Julien GHANEM, Ismat LAFAGE, Virginie SKALLI, Wafa ASSI, Ayman Purpose To describe spinopelvic adaptations in the standing and sitting positions in patients with adult spinal deformity (ASD). Methods Ninety-five patients with ASD and 32 controls completed health-related quality of life (HRQOL) questionnaires: short form 36 (SF36), Oswestry Disability Index (ODI), and visual analog scale (VAS) for pain. They underwent biplanar radiography in both standing and sitting positions. Patients with ASD were divided into ASD-front (frontal deformity Cobb > 20°, n = 24), ASD-sag (sagittal vertical axis (SVA) > 50 mm, pelvic tilt (PT) > 25°, or pelvic incidence (PI)-lumbar lordosis (LL) > 10°, n = 40), and ASD-hyper thoracic kyphosis (TK >60°, n = 31) groups. Flexibility was defined as the difference (Δ) in radiographic parameters between the standing and sitting positions. The radiographic parameters were compared between the groups. Correlations between HRQOL scores were evaluated. Results All participants increased their SVA from standing to sitting (ΔSVA<0), except for patients with ASD-sag, who tended to decrease their SVA (78-62 mm) and maximize their pelvic retroversion (27-40° vs 10-34° in controls, p<0.001). They also showed reduced thoracic and lumbar flexibility (ΔLL = 3.4 vs 37.1°; ΔTK = −1.7 vs 9.4° in controls, p<0.001). ASD-hyperTK showed a decreased PT while sitting (28.9 vs 34.4° in controls, p<0.001); they tended to decrease their LL and TK but could not reach values for controls (ΔLL = 22.8 vs 37.1° and ΔTK = 5.2 vs 9.4°, p<0.001). The ASD-front had normal standing and sitting postures. ΔSVA and ΔLL were negatively correlated with the physical component scale (PCS of SF36) and ODI (r = −0.39 and r = −0.46, respectively). Conclusion Patients with ASD present with different spinopelvic postures and adaptations from standing to sitting positions, with those having sagittal malalignment most affected. In addition, changes in standing and sitting postures were related to HRQOL outcomes. Therefore, surgeons should consider patient sitting adaptations in surgical planning and spinal fusion. Future studies on ASD should evaluate whether physical therapy or spinal surgery can improve sitting posture and QOL, especially for those with high SVA or PT. http://hdl.handle.net/10985/26001 Kinematic adaptations from self-selected to fast speed walking in patients with adult spinal deformity ABI KARAM, Krystel; EL RACHKIDI, Rami; SEMAAN, Karl; SAAD, Eddy; FAKHOURY, Marc; SAADE, Maria; AYOUB, Elma; RTEIL, Ali; JABER, Elena; MEKHAEL, Elio; NASSIM, Nabil; MASSAAD, Abir; GHANEM, Ismat; ASSI, Ayman Purpose To investigate kinematic adaptations from self-selected to fast speed walking in ASD patients. Methods 115 primary ASD and 66 controls underwent biplanar radiographic X-rays and 3D gait analysis to calculate trunk, segmental spine and lower limb kinematics during self-selected and fast speed walking. Kinematic adaptation was calculated as the difference (Δ) between fast and self-selected speed walking. ASD with 7 or more limited kinematic adaptation parameters were classified as ASD-limited-KA, while those with less than 7 limited kinematic adaptation parameters were classified as ASD-mild-KA. Results 25 patients were classified as ASD-limited-KA and 90 as ASD-mild-KA. ASD-limited-KA patients walked with a lesser increase of pelvic rotation (Δ = 1.7 vs 5.5°), sagittal hip movement (Δ = 3.1 vs 7.4°) and shoulder–pelvis axial rotation (Δ = 3.4 vs 6.4°) compared to controls (all p < 0.05). ASD-limited-KA had an increased SVA (60.6 vs − 5.7 mm), PT (23.7 vs 11.9°), PI–LL (9.7 vs − 11.7°), knee flexion (9.2 vs − 0.4°) and a decreased LL (44.0 vs 61.4°) compared to controls (all p < 0.05). Kinematic and radiographic alterations were less pronounced in ASD-mild-KA. The limited increase of walking speed was correlated to the deteriorated physical component summary score of SF-36 (r = 0.37). Discussion Kinematic limitations during adaptation from self-selected to fast speed walking highlight an alteration of a daily life activity in ASD patients. ASD with limited kinematic adaptations showed more severe sagittal malalignment with an increased SVA, PT, PI–LL, and knee flexion, a decreased LL and the most deteriorated quality of life. This highlights the importance of 3D movement analysis in the evaluation of ASD. Mon, 01 Jan 2024 00:00:00 GMT http://hdl.handle.net/10985/26001 2024-01-01T00:00:00Z ABI KARAM, Krystel EL RACHKIDI, Rami SEMAAN, Karl SAAD, Eddy FAKHOURY, Marc SAADE, Maria AYOUB, Elma RTEIL, Ali JABER, Elena MEKHAEL, Elio NASSIM, Nabil MASSAAD, Abir GHANEM, Ismat ASSI, Ayman Purpose To investigate kinematic adaptations from self-selected to fast speed walking in ASD patients. Methods 115 primary ASD and 66 controls underwent biplanar radiographic X-rays and 3D gait analysis to calculate trunk, segmental spine and lower limb kinematics during self-selected and fast speed walking. Kinematic adaptation was calculated as the difference (Δ) between fast and self-selected speed walking. ASD with 7 or more limited kinematic adaptation parameters were classified as ASD-limited-KA, while those with less than 7 limited kinematic adaptation parameters were classified as ASD-mild-KA. Results 25 patients were classified as ASD-limited-KA and 90 as ASD-mild-KA. ASD-limited-KA patients walked with a lesser increase of pelvic rotation (Δ = 1.7 vs 5.5°), sagittal hip movement (Δ = 3.1 vs 7.4°) and shoulder–pelvis axial rotation (Δ = 3.4 vs 6.4°) compared to controls (all p < 0.05). ASD-limited-KA had an increased SVA (60.6 vs − 5.7 mm), PT (23.7 vs 11.9°), PI–LL (9.7 vs − 11.7°), knee flexion (9.2 vs − 0.4°) and a decreased LL (44.0 vs 61.4°) compared to controls (all p < 0.05). Kinematic and radiographic alterations were less pronounced in ASD-mild-KA. The limited increase of walking speed was correlated to the deteriorated physical component summary score of SF-36 (r = 0.37). Discussion Kinematic limitations during adaptation from self-selected to fast speed walking highlight an alteration of a daily life activity in ASD patients. ASD with limited kinematic adaptations showed more severe sagittal malalignment with an increased SVA, PT, PI–LL, and knee flexion, a decreased LL and the most deteriorated quality of life. This highlights the importance of 3D movement analysis in the evaluation of ASD. http://hdl.handle.net/10985/21536 Global postural malalignment in adolescent idiopathic scoliosis: The axial deformity is the main driver KARAM, Mohamad; GHANEM, Ismat; VERGARI, Claudio; KHALIL, Nour; SAADE, Maria; CHAAYA, Céline; RTEIL, Ali; AYOUB, Elma; SAAD, Eddy; KHARRAT, Khalil; SKALLI, Wafa; ASSI, Ayman Purpose: To evaluate the global alignment of non-operated subjects with adolescent idiopathic scoliosis. Method: A total of 254 subjects with AIS and 64 controls underwent low dose biplanar X-rays and had their spine, pelvis, and rib cage reconstructed in 3D. Global alignment was measured in the sagittal and frontal planes by calculating the OD-HA angle (between C2 dens to hip axis with the vertical). Subjects with AIS were classified as malaligned if the OD-HA was > 95th percentile relative to controls. Results: The sagittal OD-HA in AIS remained within the normal ranges. In the frontal plane, 182 AIS were normally aligned (Group 1, OD-HA = 0.9°) but 72 were malaligned (Group 2, OD-HA = 2.9°). Group 2 had a more severe spinal deformity in the frontal and horizontal planes compared to Group 1 (Cobb: 42 ± 16° vs. 30 ± 18°; apical vertebral rotation AVR: 19 ± 10° vs. 12 ± 7°, all p < 0.05). Group 2 subjects were mainly classified as Lenke 5 or 6. 19/72 malaligned subjects had a mild deformity (Cobb < 30°) but a progressive scoliosis (severity index ≥ 0.6). The frontal OD-HA angle was found to be mainly determined (adjusted-R2 = 0.22) by the apical vertebral rotation and secondarily by the Lenke type. Conclusions: This study showed that frontal malalignment is more common in distal major structural scoliosis and its main driver is the apical vertebral rotation. This highlights the importance of monitoring the axial plane deformity in order to avoid worsening of the frontal global alignment. Sat, 01 Jan 2022 00:00:00 GMT http://hdl.handle.net/10985/21536 2022-01-01T00:00:00Z KARAM, Mohamad GHANEM, Ismat VERGARI, Claudio KHALIL, Nour SAADE, Maria CHAAYA, Céline RTEIL, Ali AYOUB, Elma SAAD, Eddy KHARRAT, Khalil SKALLI, Wafa ASSI, Ayman Purpose: To evaluate the global alignment of non-operated subjects with adolescent idiopathic scoliosis. Method: A total of 254 subjects with AIS and 64 controls underwent low dose biplanar X-rays and had their spine, pelvis, and rib cage reconstructed in 3D. Global alignment was measured in the sagittal and frontal planes by calculating the OD-HA angle (between C2 dens to hip axis with the vertical). Subjects with AIS were classified as malaligned if the OD-HA was > 95th percentile relative to controls. Results: The sagittal OD-HA in AIS remained within the normal ranges. In the frontal plane, 182 AIS were normally aligned (Group 1, OD-HA = 0.9°) but 72 were malaligned (Group 2, OD-HA = 2.9°). Group 2 had a more severe spinal deformity in the frontal and horizontal planes compared to Group 1 (Cobb: 42 ± 16° vs. 30 ± 18°; apical vertebral rotation AVR: 19 ± 10° vs. 12 ± 7°, all p < 0.05). Group 2 subjects were mainly classified as Lenke 5 or 6. 19/72 malaligned subjects had a mild deformity (Cobb < 30°) but a progressive scoliosis (severity index ≥ 0.6). The frontal OD-HA angle was found to be mainly determined (adjusted-R2 = 0.22) by the apical vertebral rotation and secondarily by the Lenke type. Conclusions: This study showed that frontal malalignment is more common in distal major structural scoliosis and its main driver is the apical vertebral rotation. This highlights the importance of monitoring the axial plane deformity in order to avoid worsening of the frontal global alignment. http://hdl.handle.net/10985/21775 Assessment of dynamic balance during walking in patients with adult spinal deformity REBEYRAT, Guillaume; SKALLI, Wafa; RACHKIDI, Rami; PILLET, Helene; MASSAAD, Abir; MEHANNA, Joe; SEMAAN, Karl; SAAD, Eddy; GHANEM, Ismat; ASSI, Ayman 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. Sat, 01 Jan 2022 00:00:00 GMT http://hdl.handle.net/10985/21775 2022-01-01T00:00:00Z REBEYRAT, Guillaume SKALLI, Wafa RACHKIDI, Rami PILLET, Helene MASSAAD, Abir MEHANNA, Joe SEMAAN, Karl SAAD, Eddy GHANEM, Ismat ASSI, Ayman 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. http://hdl.handle.net/10985/20470 Gait kinematic alterations in subjects with adult spinal deformity and their radiological determinants KAWKABANI, Georges; SALIBY, Renée Maria; MEKHAEL, Mario; RACHKIDI, Rami; MASSAAD, Abir; GHANEM, Ismat; KHARRAT, Khalil; KREICHATI, Gaby; SAAD, Eddy; LAFAGE, Virginie; LAFAGE, Renaud; SKALLI, Wafa; ASSI, Ayman Background: Adults with spinal deformity (ASD) are known to have postural malalignment affecting their quality of life. Classical evaluation and follow-up are usually based on full-body static radiographs and health related quality of life questionnaires. Despite being an essential daily life activity, formal gait assessment lacks in clinical practice. Research Question: What are the main alterations in gait kinematics of ASD and their radiological determinants? Methods: 52 ASD and 63 control subjects underwent full-body 3D gait analysis with calculation of joint kinematics and full-body biplanar X-rays with calculation of 3D postural parameters. Kinematics and postural parameters were compared between groups. Determinants of gait alterations among postural radiographic parameters were explored. Results: ASD had increased sagittal vertical axis (SVA:34 ± 59 vs −5 ± 20 mm), pelvic tilt (PT:19 ± 13 vs 11 ± 6°) and frontal Cobb (25 ± 21 vs 4 ± 6°) compared to controls (all p < 0.001). ASD displayed decrease walking speed (0.9 ± 0.3 vs 1.2 ± 0.2 m/s), step length (0.58 ± 0.11 vs 0.64 ± 0.07 m) and increased single support (0.45 ± 0.05 vs 0.42 ± 0.04 s). ASD walked with decreased hip extension in stance (−3 ± 10 vs −7 ± 8°), increased knee flexion at initial contact and in stance (10 ± 11 vs 5 ± 10° and 19 ± 7 vs 16 ± 8° respectively), and decreased knee flexion/extension ROM (55 ± 9 vs 59 ± 7°). ASD had increased trunk flexion (12 ± 12 vs 6 ± 11°) and reduced dynamic lumbar lordosis (−11 ± 12 vs −15 ± 7°, all p < 0.001). Sagittal knee ROM, walking speed and step length were negatively determined by SVA; lack of lumbar lordosis during gait was negatively determined by radiological lumbar lordosis. Significance: Static compensations in ASD persist during gait, where they exhibit a flexed attitude at the trunk, hips and knees, reduced hip and knee mobility and loss of dynamic lordosis. ASD walked at a slower pace with increased single and double support times that might contribute to their gait stability. These dynamic discrepancies were strongly related to static sagittal malalignment. Fri, 01 Jan 2021 00:00:00 GMT http://hdl.handle.net/10985/20470 2021-01-01T00:00:00Z KAWKABANI, Georges SALIBY, Renée Maria MEKHAEL, Mario RACHKIDI, Rami MASSAAD, Abir GHANEM, Ismat KHARRAT, Khalil KREICHATI, Gaby SAAD, Eddy LAFAGE, Virginie LAFAGE, Renaud SKALLI, Wafa ASSI, Ayman Background: Adults with spinal deformity (ASD) are known to have postural malalignment affecting their quality of life. Classical evaluation and follow-up are usually based on full-body static radiographs and health related quality of life questionnaires. Despite being an essential daily life activity, formal gait assessment lacks in clinical practice. Research Question: What are the main alterations in gait kinematics of ASD and their radiological determinants? Methods: 52 ASD and 63 control subjects underwent full-body 3D gait analysis with calculation of joint kinematics and full-body biplanar X-rays with calculation of 3D postural parameters. Kinematics and postural parameters were compared between groups. Determinants of gait alterations among postural radiographic parameters were explored. Results: ASD had increased sagittal vertical axis (SVA:34 ± 59 vs −5 ± 20 mm), pelvic tilt (PT:19 ± 13 vs 11 ± 6°) and frontal Cobb (25 ± 21 vs 4 ± 6°) compared to controls (all p < 0.001). ASD displayed decrease walking speed (0.9 ± 0.3 vs 1.2 ± 0.2 m/s), step length (0.58 ± 0.11 vs 0.64 ± 0.07 m) and increased single support (0.45 ± 0.05 vs 0.42 ± 0.04 s). ASD walked with decreased hip extension in stance (−3 ± 10 vs −7 ± 8°), increased knee flexion at initial contact and in stance (10 ± 11 vs 5 ± 10° and 19 ± 7 vs 16 ± 8° respectively), and decreased knee flexion/extension ROM (55 ± 9 vs 59 ± 7°). ASD had increased trunk flexion (12 ± 12 vs 6 ± 11°) and reduced dynamic lumbar lordosis (−11 ± 12 vs −15 ± 7°, all p < 0.001). Sagittal knee ROM, walking speed and step length were negatively determined by SVA; lack of lumbar lordosis during gait was negatively determined by radiological lumbar lordosis. Significance: Static compensations in ASD persist during gait, where they exhibit a flexed attitude at the trunk, hips and knees, reduced hip and knee mobility and loss of dynamic lordosis. ASD walked at a slower pace with increased single and double support times that might contribute to their gait stability. These dynamic discrepancies were strongly related to static sagittal malalignment. http://hdl.handle.net/10985/20457 Toward understanding the underlying mechanisms of pelvic tilt reserve in adult spinal deformity: the role of the 3D hip orientation MEKHAEL, Mario; KAWKABANI, Georges; SALIBY, Renée Maria; SKALLI, Wafa; SAAD, Eddy; JABER, Elena; RACHKIDI, Rami; KHARRAT, Khalil; KREICHATI, Gaby; GHANEM, Ismat; LAFAGE, Virginie; ASSI, Ayman Purpose: To explore 3D hip orientation in standing position in subjects with adult spinal deformity (ASD) presenting with different levels of compensatory mechanisms. Methods: Subjects with ASD (n = 159) and controls (n = 68) underwent full-body biplanar X-rays with the calculation of 3D spinopelvic, postural and hip parameters. ASD subjects were grouped as ASD with knee flexion (ASD-KF) if they compensated by flexing their knees (knee flexion ≥ 5°), and ASD with knee extension (ASD-KE) otherwise (knee flexion < 5°). Spinopelvic, postural and hip parameters were compared between the three groups. Univariate and multivariate analyses were then computed between spinopelvic and hip parameters. Results: ASD-KF had higher SVA (67 ± 66 mm vs. 2 ± 33 mm and 11 ± 21 mm), PT (27 ± 14° vs. 18 ± 9° and 11 ± 7°) and PI-LL mismatch (20 ± 26° vs − 1 ± 18° and − 13 ± 10°) when compared to ASD-KE and controls (all p < 0.05). ASD-KF also had a more tilted (34 ± 11° vs. 28 ± 9° and 26 ± 7°), anteverted (24 ± 6° vs. 20 ± 5° and 18 ± 4°) and abducted (59 ± 6° vs. 57 ± 4° and 56 ± 4°) acetabulum, with a higher posterior coverage (100 ± 6° vs. 97 ± 7° for ASD-KE) when compared to ASD-KE and controls (all p < 0.05). The main determinants of acetabular tilt, acetabular abduction and anterior acetabular coverage were PT, SVA and LL (adjusted R² [0.12; 0.5]). Conclusions: ASD subjects compensating with knee flexion have altered hip orientation, characterized by increased posterior coverage (acetabular anteversion, tilt and posterior coverage) and decreased anterior coverage which can together lead to posterior femoro-acetabular impingement, thus limiting pelvic retroversion. This underlying mechanism could be potentially involved in the hip-spine syndrome. Fri, 01 Jan 2021 00:00:00 GMT http://hdl.handle.net/10985/20457 2021-01-01T00:00:00Z MEKHAEL, Mario KAWKABANI, Georges SALIBY, Renée Maria SKALLI, Wafa SAAD, Eddy JABER, Elena RACHKIDI, Rami KHARRAT, Khalil KREICHATI, Gaby GHANEM, Ismat LAFAGE, Virginie ASSI, Ayman Purpose: To explore 3D hip orientation in standing position in subjects with adult spinal deformity (ASD) presenting with different levels of compensatory mechanisms. Methods: Subjects with ASD (n = 159) and controls (n = 68) underwent full-body biplanar X-rays with the calculation of 3D spinopelvic, postural and hip parameters. ASD subjects were grouped as ASD with knee flexion (ASD-KF) if they compensated by flexing their knees (knee flexion ≥ 5°), and ASD with knee extension (ASD-KE) otherwise (knee flexion < 5°). Spinopelvic, postural and hip parameters were compared between the three groups. Univariate and multivariate analyses were then computed between spinopelvic and hip parameters. Results: ASD-KF had higher SVA (67 ± 66 mm vs. 2 ± 33 mm and 11 ± 21 mm), PT (27 ± 14° vs. 18 ± 9° and 11 ± 7°) and PI-LL mismatch (20 ± 26° vs − 1 ± 18° and − 13 ± 10°) when compared to ASD-KE and controls (all p < 0.05). ASD-KF also had a more tilted (34 ± 11° vs. 28 ± 9° and 26 ± 7°), anteverted (24 ± 6° vs. 20 ± 5° and 18 ± 4°) and abducted (59 ± 6° vs. 57 ± 4° and 56 ± 4°) acetabulum, with a higher posterior coverage (100 ± 6° vs. 97 ± 7° for ASD-KE) when compared to ASD-KE and controls (all p < 0.05). The main determinants of acetabular tilt, acetabular abduction and anterior acetabular coverage were PT, SVA and LL (adjusted R² [0.12; 0.5]). Conclusions: ASD subjects compensating with knee flexion have altered hip orientation, characterized by increased posterior coverage (acetabular anteversion, tilt and posterior coverage) and decreased anterior coverage which can together lead to posterior femoro-acetabular impingement, thus limiting pelvic retroversion. This underlying mechanism could be potentially involved in the hip-spine syndrome. http://hdl.handle.net/10985/24502 Alterations of gait kinematics depend on the deformity type in the setting of adult spinal deformity SEMAAN, Karl; RACHKIDI, Rami; SAAD, Eddy; MASSAAD, Abir; KAWKABANI, Georges; SALIBY, Renée Maria; MEKHAEL, Mario; ABI KARAM, Krystel; FAKHOURY, Marc; JABER, Elena; GHANEM, Ismat; SKALLI, Wafa; LAFAGE, Virginie; ASSI, Ayman 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. Mon, 01 Aug 2022 00:00:00 GMT http://hdl.handle.net/10985/24502 2022-08-01T00:00:00Z SEMAAN, Karl RACHKIDI, Rami SAAD, Eddy MASSAAD, Abir KAWKABANI, Georges SALIBY, Renée Maria MEKHAEL, Mario ABI KARAM, Krystel FAKHOURY, Marc JABER, Elena GHANEM, Ismat SKALLI, Wafa LAFAGE, Virginie ASSI, Ayman 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.