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Gait kinematic alterations in subjects with adult spinal deformity and their radiological determinants

Article dans une revue avec comité de lecture
Author
KAWKABANI, Georges
301405 Université Saint-Joseph de Beyrouth [USJ]
SALIBY, Renée Maria
301405 Université Saint-Joseph de Beyrouth [USJ]
MEKHAEL, Mario
301405 Université Saint-Joseph de Beyrouth [USJ]
RACHKIDI, Rami
301405 Université Saint-Joseph de Beyrouth [USJ]
MASSAAD, Abir
301405 Université Saint-Joseph de Beyrouth [USJ]
GHANEM, Ismat
301405 Université Saint-Joseph de Beyrouth [USJ]
KHARRAT, Khalil
301405 Université Saint-Joseph de Beyrouth [USJ]
KREICHATI, Gaby
301405 Université Saint-Joseph de Beyrouth [USJ]
SAAD, Eddy
301405 Université Saint-Joseph de Beyrouth [USJ]
LAFAGE, Virginie
358726 Hospital for Special Surgery
LAFAGE, Renaud
358726 Hospital for Special Surgery
ccSKALLI, Wafa
1001017 Institut de Biomécanique Humaine Georges Charpak [IBHGC]
ASSI, Ayman
301405 Université Saint-Joseph de Beyrouth [USJ]
1001017 Institut de Biomécanique Humaine Georges Charpak [IBHGC]

URI
http://hdl.handle.net/10985/20470
DOI
10.1016/j.gaitpost.2021.06.003
Date
2021
Journal
Gait & Posture

Abstract

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.

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