Different kinematic strategies are adopted by AIS patients during walking depending on Lenke type

Abstract

Introduction Adolescent Idiopathic Scoliosis (AIS) is classically evaluated through static X-rays and health-related quality of life questionnaires that do not reflect the functional limitations of patients during daily life activities, such as walking. The aim was to investigate kinematic strategies in non-operated AIS with different types of curvature during walking using 3D gait analysis. Methods 13 AIS with Lenke 5 (major Cobb: 23 ± 8°), 30 AIS with Lenke 1 (major Cobb: 40 ± 14°) in addition to 24 controls underwent biplanar X-rays followed by 3D gait analysis. The kinematic parameters of the head, trunk, spinal segments, pelvis and lower limbs were compared between groups. Results AIS Lenke 5 had a lumbar segment bending while walking (T12L3-L3L5: 5 ± 7° vs. -3 ± 7° in controls) to the concave side of the scoliosis. They walked with an increased pelvic frontal mobility (12 ± 3° vs. 9 ± 3°) and internal rotation of the right foot (-2 ± 6° vs. -11 ± 8°; all p < 0.05). AIS Lenke 1 increased their thoracic & lumbar segment bending to the concave and to the opposite side respectively (T6T9-T9T12: -4 ± 9° vs. 1 ± 4°; T12L3-L3L5: 8 ± 12° vs. -2 ± 7°). However, they tended to reduce their lumbo-pelvic mobility (7 ± 5° vs. 12 ± 5°; all p < 0.05). Conclusion In response to their inherent lumbar stiffness and bending, AIS Lenke 5 patients tended to increase their pelvic frontal mobility and to develop a homolateral internal foot rotation, ensuring a dynamic alignment during gait. AIS Lenke 1, by producing opposite bending movement at the thoracic and lumbar segments, tended to reduce their lumbo-pelvic mobility and ensure coronal dynamic alignment.