1
|
Gou Y, Tao J, Huang J, Lei H, Chen X, Wang X. Biomechanical analysis of trunk and lower limbs during stair activity in patients with scoliosis. Sci Rep 2024; 14:14541. [PMID: 38914617 PMCID: PMC11196649 DOI: 10.1038/s41598-024-65665-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/22/2024] [Indexed: 06/26/2024] Open
Abstract
Staircases are a frequently encountered obstacle in daily life, requiring individuals to navigate ascending and descending movements that place additional demands on the trunk and lower limbs compared to walking on level surfaces. Therefore, it is crucial to examine the biomechanical characteristics of the trunk and lower limbs in individuals with scoliosis during stair activity. The aim of this study was to investigate the biomechanical differences in trunk and lower limbs during daily stair activities between patients with scoliosis and a healthy population. Additionally, the study aimed to explore the relationship between trunk abnormalities and lower limb biomechanics, providing a clinical and objective assessment basis for scoliosis. The Qualisys system, based in Gothenburg, Sweden, was employed for data collection in this study, with a sampling frequency of 150 Hz. It captured the kinematics of the trunk and lower limbs, as well as the kinetics of the lower limbs during stair ascent and descent for both the 28 individuals with scoliosis and the 28 control participants. The results indicate that scoliosis patients demonstrated significantly higher asymmetry compared to the control group in various measures during ascent and decent. These include different parts of kinematics and kinetics. Scoliosis patients demonstrate noticeable variations in their movement patterns compared to the healthy population when engaging in stair activities. Specifically, during stair ascent, scoliosis patients exhibit a seemingly more rigid movement pattern, whereas descent is characterized by an unstable pattern.
Collapse
Affiliation(s)
- Yanyun Gou
- Fujian University of Traditional Chinese Medicine, No.1 Qiuyang Road, Minhou Shangjie, Fuzhou, 350122, Fujian, China
| | - Jing Tao
- Fujian University of Traditional Chinese Medicine, No.1 Qiuyang Road, Minhou Shangjie, Fuzhou, 350122, Fujian, China
| | - Jia Huang
- Fujian University of Traditional Chinese Medicine, No.1 Qiuyang Road, Minhou Shangjie, Fuzhou, 350122, Fujian, China
| | - Huangwei Lei
- Fujian University of Traditional Chinese Medicine, No.1 Qiuyang Road, Minhou Shangjie, Fuzhou, 350122, Fujian, China
| | - Xiang Chen
- Fujian University of Traditional Chinese Medicine, No.1 Qiuyang Road, Minhou Shangjie, Fuzhou, 350122, Fujian, China
| | - Xiangbin Wang
- Fujian University of Traditional Chinese Medicine, No.1 Qiuyang Road, Minhou Shangjie, Fuzhou, 350122, Fujian, China.
| |
Collapse
|
2
|
Çetinkaya İ, Kuru Çolak T, Korkmaz MF, Aydoğan M. The effect of spinal range of motion on functional balance, quality of life, and perception of appearance in adolescent idiopathic scoliosis after posterior spinal fusion surgery. Ir J Med Sci 2024; 193:1307-1312. [PMID: 37943401 DOI: 10.1007/s11845-023-03563-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE Spinal fusion, which is widely used in the surgical treatment of adolescent idiopathic scoliosis (AIS), limits the movements of the vertebral column. In this study, it was aimed to investigate the relationship between spinal mobility in the postoperative period with functional balance, quality of life, and perception of appearance in individuals with AIS. METHODS Thirty patients with AIS who underwent posterior spinal fusion surgery 1 to 3 years ago were included in the study. A universal goniometer was used to measure a spinal range of motion (ROM), functional reach test for functional balance, Scoliosis Research Society-30 (SRS-30) for quality of life, and Spinal Appearance Questionnaire (SAQ) for perception of appearance. RESULTS Surgical fusion length was significantly correlated with movements in the sagittal and transverse planes (r = - 0.383-[- 0.608]; p = < 0.001-0.037). Except for spinal left rotation, there was a significant positive correlation between functional balance level and ROM results (r = 0.374-0.523; p = 0.003-0.42). The SRS-30 total score correlated significantly with all other ROM measures except for rotations (r = 0.434-0.574; p = 0.00-0.016). SAQ total data correlated significantly with all ROM measurements (r = - 0.553-[- 0.395]; p = 0.002-0.031). CONCLUSIONS In AIS, limitation of movement in the coronal, sagittal, and transverse planes is observed after fusion surgery. Spinal ROM is affected by the level of fusion performed at surgery. Postoperative spinal limitation of motion adversely affected functional balance, quality of life, and perception of appearance. We believe that comprehensive rehabilitation approaches that improve postoperative range of motion and increase functionality are important for optimal postoperative recovery.
Collapse
Affiliation(s)
- İrem Çetinkaya
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Marmara University, Istanbul, Turkey.
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Haliç University, 5. Levent Mahallesi, 15 Temmuz Şehitler Cd. No: 14 / 12, Istanbul, Eyüpsultan, 34060, Turkey.
| | - Tuğba Kuru Çolak
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Mehmet Fatih Korkmaz
- Department of Orthopedics and Traumatology, Prof. Dr Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mehmet Aydoğan
- Advanced Spine Surgery Center, Department of Orthopedic Surgery and Traumatology, Emsey Hospital, Istanbul, Turkey
| |
Collapse
|
3
|
He Y, Dong H, Lei M, Liu J, Xie H, Zhang Z, Pang J, Jin M, Wang J, Geng Z, Zhang J, Li G, Yang Q, Meng L, Miao J. The role of the paraspinal muscles in the development of adolescent idiopathic scoliosis based on surface electromyography and radiographic analysis. BMC Musculoskelet Disord 2024; 25:263. [PMID: 38570738 PMCID: PMC10993478 DOI: 10.1186/s12891-024-07329-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 03/01/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Patients with idiopathic scoliosis commonly present with an imbalance of the paraspinal muscles. However, it is unclear whether this muscle imbalance is an underlying cause or a result of idiopathic scoliosis. This study aimed to investigate the role of paraspinal muscles in the development of idiopathic scoliosis based on surface electromyography (sEMG) and radiographic analyses. METHODS This was a single-center prospective study of 27 patients with single-curve idiopathic scoliosis. Posteroanterior whole-spine radiographs and sEMG activity of the erector spinae muscles were obtained for all patients in the habitual standing position (HSP), relaxed prone position (RPP), and prone extension position (PEP). The Cobb angle, symmetrical index (SI) of the sEMG activity (convex/concave), and correlation between the two factors were analyzed. RESULTS In the total cohort, the mean Cobb angle in the HSP was significantly greater than the mean Cobb angle in the RPP (RPP-Cobb) (p < 0.001), whereas the mean Cobb angle in the PEP (PEP-Cobb) did not differ from the RPP-Cobb. Thirteen patients had a PEP-Cobb that was significantly smaller than their RPP-Cobb (p = 0.007), while 14 patients had a PEP-Cobb that was significantly larger than their RPP-Cobb (p < 0.001). In the total cohort and two subgroups, the SI of sEMG activity at the apex vertebra (AVSI) in the PEP was significantly greater than 1, revealing significant asymmetry, and was also significantly larger than the AVSI in the RPP. In the RPP, the AVSI was close to 1 in the total cohort and two subgroups, revealing no significant asymmetry. CONCLUSION The coronal Cobb angle and the SI of paraspinal muscle activity in AIS patients vary with posture changes. Asymmetrical sEMG activity of the paraspinal muscles may be not an inherent feature of AIS patients, but is evident in the challenging tasks. The potential significance of asymmetric paraspinal muscle activity need to be explored in further research.
Collapse
Affiliation(s)
- Yinchuan He
- Graduate School, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, No.406, Jiefang South Road, Hexi District, Tianjin, 300210, China
- Department of Spine Surgery, Hebei Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine, No.31 Huanghe Road, Cangzhou, 061001, China
| | - Hongtao Dong
- Academy of Medical Engineering and Translational Medicine, Tianjin University, No. 92 Weijin Road, Nankai District, Tianjin, 300072, China
| | - Ming Lei
- Graduate School, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Jianan Liu
- Graduate School, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, No.406, Jiefang South Road, Hexi District, Tianjin, 300210, China
| | - Hongru Xie
- Graduate School, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Zepei Zhang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, No.406, Jiefang South Road, Hexi District, Tianjin, 300210, China
| | - Jun Pang
- Academy of Medical Engineering and Translational Medicine, Tianjin University, No. 92 Weijin Road, Nankai District, Tianjin, 300072, China
| | - Mengyue Jin
- Academy of Medical Engineering and Translational Medicine, Tianjin University, No. 92 Weijin Road, Nankai District, Tianjin, 300072, China
| | - Jian Wang
- Graduate School, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Ziming Geng
- Graduate School, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Jing'an Zhang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, No.406, Jiefang South Road, Hexi District, Tianjin, 300210, China
| | - Gang Li
- The Second Department of Radiology, Tianjin Hospital, Tianjin University, No.406 Jiefang South Road, Hexi District, Tianjin, 300210, China
| | - Qilong Yang
- The Second Department of Radiology, Tianjin Hospital, Tianjin University, No.406 Jiefang South Road, Hexi District, Tianjin, 300210, China
| | - Lin Meng
- Academy of Medical Engineering and Translational Medicine, Tianjin University, No. 92 Weijin Road, Nankai District, Tianjin, 300072, China.
| | - Jun Miao
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, No.406, Jiefang South Road, Hexi District, Tianjin, 300210, China.
| |
Collapse
|
4
|
Tekin S, Yagci G, Topuz S, Demirkiran G. Comparison of gait and sagittal plane arm swing between individuals with adolescent idiopathic scoliosis and healthy individuals. Acta Orthop Belg 2023; 89:727-734. [PMID: 38205767 DOI: 10.52628/89.4.11444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Arm swing and energy consumption play an important role in the realization of an effective gait. However, research on arm swing and energy consumption during gait in individuals with adolescent idiopathic scoliosis (AIS) is limited. The aim of this study was to investigate the spatiotemporal characteristics of gait, arm swing angles in the sagittal plane, energy consumption in individuals with AIS, to compare them with their healthy peers in this regard. 26 diagnosed with AIS and 21 healthy were included in this study. Evaluation measures were based on the Cobb angle, axial trunk rotation, trunk symmetry, sagittal curve measurements, spatiotemporal characteristics of gait with the GAITRite electronic walkway, sagittal plane arm swing with two video-camera recordings, and energy consumption. There were a decrease in right- sided sagittal arm swing, an increase in energy consumption, in left-side step time and right-side double support time in the scoliosis group compared to the control group. The other spatiotemporal characteristics of the gait were similar in both groups. The evaluation of arm swing, energy consumption, and gait of individuals with AIS may contribute to the development of rehabilitation programs by better identifying the deficiencies of individuals with AIS.
Collapse
|
5
|
Laett CT, Visconti RDR, Meirelles RDSP, Santos LDM, Cossich VRA, Silva SCD. Effect of Spinal Correction Surgery on Lower Limb Strength in Idiopathic Adolescent Scoliosis. Rev Bras Ortop 2023; 58:e912-e916. [PMID: 38077772 PMCID: PMC10708971 DOI: 10.1055/s-0043-1770980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/27/2023] [Indexed: 08/03/2024] Open
Abstract
Objectives To analyze the lower limb strength in both untreated and surgically treated adolescent idiopathic scoliosis (AIS) patients and examine its correlation with the distance covered in a six-minute walking test (6MWT). Methods A total of 88 participants (n = 30 pre-surgery AIS patients, n = 30 post-surgical AIS patients, and n = 28 control) underwent a 6MWT and a muscle strength assessment. The lower limb strength was measured at the knee joint using the knee extension (KE) and knee flexion (KF) peak torque (PT) measurements. Results The control group covered a greater distance in the TC6 compared to both the pre-surgical (534 ± 67 m) and post-surgical (541 ± 69 m) groups, with a distance of 612 ± 70 m (p < 0.001). No differences were observed in KE PT (pre: 2.1 ± 0.63, post: 2.1 ± 0.7, control: 2.2 ± 0.7 Nm.kg -1 , p = 0.67) or KF PT (pre: 1.0 ± 0.3, post: 1.1 ± 0.3, control: 1.1 ± 0.5 Nm.kg -1 , p = 0.46). A moderate positive correlation was observed between KE PT and 6MWT distance (r = 0.53, p < 0.001), as well as a low positive correlation for KF PT (r = 0.37, p = 0.003) with 6MWT distance. Conclusion This study highlights the importance of lower limb maximal strength in the functionality of AIS patients. Our findings suggest that exercise programs aimed at enhancing lower limb strength, especially the KE, could improve the walking capacity of AIS patients. These results provide useful information for designing purposeful exercise programs for AIS patients with walking deficits.
Collapse
Affiliation(s)
- Conrado Torres Laett
- Instituto Nacional de Traumatologia e Ortopedia (INTO), Divisão de Ensino e Pesquisa (DIENP), Programa de Pós-Graduação em Ciências Aplicadas ao Sistema Musculoesquelético, Rio de Janeiro, RJ. Brasil.
- Instituto Nacional de Traumatologia e Ortopedia (INTO), Laboratório de Pesquisa em Fisiologia do Exercício, Divisão de Pesquisa, Rio de Janeiro, RJ, Brasil.
- Instituto Nacional de Traumatologia e Ortopedia (INTO), Laboratório de Pesquisa Neuromuscular, Divisão de Pesquisa, Rio de Janeiro, RJ, Brasil.
| | - Rogério dos Reis Visconti
- Instituto Nacional de Traumatologia e Ortopedia (INTO), Divisão de Ensino e Pesquisa (DIENP), Programa de Pós-Graduação em Ciências Aplicadas ao Sistema Musculoesquelético, Rio de Janeiro, RJ. Brasil.
| | | | - Lenifran de Matos Santos
- Programa de Pós-Graduação em Ciências do Exercício e do Esporte, Universidade Estadual do Rio de Janeiro, RJ, Brasil.
| | | | - Sidnei Cavalcante da Silva
- Instituto Nacional de Traumatologia e Ortopedia (INTO), Divisão de Ensino e Pesquisa (DIENP), Programa de Pós-Graduação em Ciências Aplicadas ao Sistema Musculoesquelético, Rio de Janeiro, RJ. Brasil.
- Instituto Nacional de Traumatologia e Ortopedia (INTO), Laboratório de Pesquisa em Fisiologia do Exercício, Divisão de Pesquisa, Rio de Janeiro, RJ, Brasil.
- Instituto Nacional de Traumatologia e Ortopedia (INTO), Laboratório de Pesquisa Neuromuscular, Divisão de Pesquisa, Rio de Janeiro, RJ, Brasil.
| |
Collapse
|
6
|
Boulcourt S, Badel A, Pionnier R, Neder Y, Ilharreborde B, Simon AL. A gait functional classification of adolescent idiopathic scoliosis (AIS) based on spatio-temporal parameters (STP). Gait Posture 2023; 102:50-55. [PMID: 36905785 DOI: 10.1016/j.gaitpost.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/04/2023] [Accepted: 03/06/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Therapeutic decisions for patients with adolescent idiopathic scoliosis (AIS) are mostly based on static measurements performed on two-dimensional standing full-spine radiographs. However, the trunk plays an essential role in the human locomotion, and the functional consequences during daily activities of this specific and common spinal deformity are not factored in. RESEARCH QUESTION Does patients with AIS have specific gait patterns based on spatio-temporals parameters measurements ? METHODS 90 AIS patients (aged 10-18 years) with preoperative simplified gait analysis were retrospectively included for analysis between 2017 and 2020. Spatio-temporal parameters (STP) were measured on a 3-m baropodometric gaitway and included the measurement of 15 normalized gait parameters. A hierarchical cluster analysis was performed to identify group of patients based on the similarities of their gait patterns, and functional variables' inter-group differences were also measured. The subject distribution was calculated to identify the structural characteristics of the subjects according to their gait patterns. RESULTS Three gait patterns were identified. Cluster 1 (46%) was defined by asymmetry, Cluster 2 (16%) by instability, and Cluster 3 (36%) by variability. Each cluster was significantly different from the other ones on at least 6 different parameters (p < 0.05). Furthermore, each cluster was associated with one type of curve: Lenke 1 for Cluster 1 (57.5%), Lenke 6 for Cluster 2 (40%) and Lenke 5 for Cluster 3 (43.5%). SIGNIFICANCE Patients with severe AIS have a dynamic signature during gait identified on STP. Understanding consequences of this deformity on gait may be an interesting avenue to study the pathological mechanisms involved in their dynamic motor organization. Furthermore, these results might also be a first step to study the effectiveness of the different therapies.
Collapse
Affiliation(s)
- Sarah Boulcourt
- Plateforme d'Analyse de la Marche (PAM), Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Anne Badel
- Unité de Biologie Fonctionnelle et Adaptative (BFA), UMR 8251, CNRS, ERL 1133, Inserm, Paris, France; Université Paris Cité, Paris, France
| | - Raphaël Pionnier
- Unité Fonctionnelle d'Analyse du Mouvement (UFAM), Hôpitaux Nationaux de Saint-Maurice, Saint-Maurice, France
| | - Yamile Neder
- Plateforme d'Analyse de la Marche (PAM), Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France; Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Brice Ilharreborde
- Université Paris Cité, Paris, France; Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Anne-Laure Simon
- Plateforme d'Analyse de la Marche (PAM), Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France; Université Paris Cité, Paris, France; Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
| |
Collapse
|
7
|
Liu Y, Li X, Dou X, Huang Z, Wang J, Liao B, Zhang X. Correlational analysis of three-dimensional spinopelvic parameters with standing balance and gait characteristics in adolescent idiopathic scoliosis: A preliminary research on Lenke V. Front Bioeng Biotechnol 2022; 10:1022376. [PMID: 36532594 PMCID: PMC9747941 DOI: 10.3389/fbioe.2022.1022376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/18/2022] [Indexed: 09/21/2023] Open
Abstract
Background: Adolescent idiopathic scoliosis (AIS), the most common spinal deformity, possibly develops due to imbalanced spinal loading following asymmetric development. Since altered loading patterns may affect standing balance and gait, we investigated whether a correlation exists between balance ability, gait pattern, and the three-dimensional radiographic spinopelvic parameters in AIS patients. Methods: A cross-sectional observational study was conducted with 34 AIS patients (aged 10-18 years) and an equal number of healthy age and sex-matched teenagers (normal group). We obtained the spinopelvic three-dimensional parameters and balance parameters simultaneously through the EOS imaging system and gait and center of pressure (CoP) characteristics using a plantar pressure measurement mat. Besides determining the intergroup differences in balance and gait parameters, multiple linear regression analyses were performed to identify any correlation between the static plantar pressure and radiographic parameters. Results: Compared to the normal group, the CoPx is lower, the CoP path length and 90% confidence ellipse area were significantly higher in AIS patients (AIS: -13.7 ± 5.7 mm, 147.4 ± 58.1 mm, 150.5 ± 62.8 mm2; normal: -7.0 ± 5.4 mm, 78.8 ± 32.0 mm, 92.1 ± 41.7 mm2, respectively), correlated with apical vertebra translation, sagittal pelvic tilt, and pelvis axial rotation, respectively. Moreover, AIS patients had a shorter stance phase (61.35 ± 0.97 s vs. 62.39 ± 1.09 s), a longer swing phase (38.66 ± 0.97 s vs. 37.62 ± 1.08 s), and smaller maximum pressure peaks in the gait cycle, especially on the left foot, as compared to healthy subjects. Moreover, the CoP trajectory in AIS patients was different from the latter, and changes in the bipedal trend were not consistent. Conclusion: The standing balance and gait characteristics of AIS patients are different from those of healthy subjects, as reflected in their three-dimensional spinopelvic radiographic parameters. Trial registration: The study protocol was registered with the Chinese Clinical Trial Registry (Number ChCTR1800018310) and the Human Subject Committee of Guangzhou Sport University (Number: 2018LCLL003).
Collapse
Affiliation(s)
- Yanan Liu
- Department of Sports Medicine, Guangzhou Sport University, Guangzhou, China
| | - Xianglan Li
- Department of Sports Medicine, Guangzhou Sport University, Guangzhou, China
| | - Xiaoran Dou
- Department of Sports Medicine, Guangzhou Sport University, Guangzhou, China
| | - Zhiguan Huang
- School of Sports and Health, Guangzhou Sport University, Guangzhou, China
| | - Jun Wang
- Gosun Medical Imaging Diagnosis Center of Guangdong Province, Guangzhou, China
| | - Bagen Liao
- Department of Sports Medicine, Guangzhou Sport University, Guangzhou, China
| | - Xiaohui Zhang
- Department of Sports Medicine, Guangzhou Sport University, Guangzhou, China
| |
Collapse
|
8
|
da Silveira GE, Andrade RM, Guilhermino GG, Schmidt AV, Neves LM, Ribeiro AP. The Effects of Short- and Long-Term Spinal Brace Use with and without Exercise on Spine, Balance, and Gait in Adolescents with Idiopathic Scoliosis. Medicina (B Aires) 2022; 58:medicina58081024. [PMID: 36013490 PMCID: PMC9413676 DOI: 10.3390/medicina58081024] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Adolescent idiopathic scoliosis (AIS) is a prevalent spinal disorder in adolescents. Previous studies have shown biomechanical changes of the gait in the lower limb of AIS patients. To minimize the progression of scoliotic curvature, a spinal brace is used, which has been shown to be efficient. Usually, a brace is worn strictly for 20–22 h every day. To our knowledge, no study has assessed the short- and long-term effects of spinal brace use with or without an exercise program (6 months) to improve clinical and biomechanical parameters. The aim of our study was to verify the effects of short- and long-term spinal brace use, with or without an exercise program on the spine, body balance, and plantar load distribution during gait in AIS. Materials and Methods: A prospective randomized study was conducted with intention-to-treat analysis in forty-five adolescents diagnosed with AIS undergoing conservative treatment at a center specialized in spinal rehabilitation. Adolescents were evaluated at two stages of intervention: (1) spinal orthopedic brace, with acute use 24 h/day (n = 22) and (2) spinal orthopedic brace, with acute use between 15–18 h/day associated with a specific rehabilitation exercise protocol for six consecutive months (six months and 12 total sessions, n = 23). The evaluated parameters were: spine pain, using a visual analog scale (VAS); Cobb angle measurement using radiograph exams, as well as the Risser sign; and static balance and plantar pressure of the feet during gait, carried out using a pressure platform. Results: AIS patients showed significant improvements in the main scoliotic curvature, with a 12-degree reduction in Cobb angle pre- and post-short-term immediate use of spinal brace and a 5.3 degree correction after six months of spinal brace use in combination with specific exercises (long term). In addition, short- and long-term brace use with an exercise program showed a significant increase in anteroposterior and mediolateral balance and a reduction in plantar overload on the heel during gait, with an effect size between moderate and high. Conclusions: Intervention via the short- or long-term use of a spinal brace combined with specific exercises in adolescents with idiopathic scoliosis proved to be effective for correcting scoliotic curvature. In addition, intervention also showed improvements to the antero-posterior and mediolateral body balance and a reduction in the plantar load on the rearfoot region during gait, demonstrating effective mechanical action on the spine.
Collapse
Affiliation(s)
- Guilherme Erdmann da Silveira
- Biomechanics and Musculoskeletal Rehabilitation Laboratory, Health Science Post-Graduate Department, Medicine School, University Santo Amaro, São Paulo 04829-300, SP, Brazil; (G.E.d.S.); (A.V.S.); (L.M.N.)
| | | | | | - Ariane Verttú Schmidt
- Biomechanics and Musculoskeletal Rehabilitation Laboratory, Health Science Post-Graduate Department, Medicine School, University Santo Amaro, São Paulo 04829-300, SP, Brazil; (G.E.d.S.); (A.V.S.); (L.M.N.)
| | - Lucas Melo Neves
- Biomechanics and Musculoskeletal Rehabilitation Laboratory, Health Science Post-Graduate Department, Medicine School, University Santo Amaro, São Paulo 04829-300, SP, Brazil; (G.E.d.S.); (A.V.S.); (L.M.N.)
- Department of Psychiatry, University of Sao Paulo, São Paulo 01246-903, SP, Brazil
| | - Ana Paula Ribeiro
- Biomechanics and Musculoskeletal Rehabilitation Laboratory, Health Science Post-Graduate Department, Medicine School, University Santo Amaro, São Paulo 04829-300, SP, Brazil; (G.E.d.S.); (A.V.S.); (L.M.N.)
- Physical Therapy Department, School of Medicine, University of São Paulo, São Paulo 01246-903, SP, Brazil
- Correspondence: ; Tel.: +55-11-99139-2168
| |
Collapse
|
9
|
Zhang Z, Liu T, Wang Y, Wang Z, Zheng G. Factors Related to Preoperative Coronal Malalignment in Degenerative Lumbar Scoliosis: An Analysis on Coronal Parameters. Orthop Surg 2022; 14:1846-1852. [PMID: 35795967 PMCID: PMC9363746 DOI: 10.1111/os.13379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/29/2022] [Accepted: 05/29/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Recently the effects of coronal malalignment (CM) in degenerative lumbar scoliosis (DLS) have been reported, however, there was few studies on the correlated parameters of coronal alignments at pre‐operation. The aims of this current study were to investigate the associations of coronal parameters with scoliosis and coronal alignment, and to explore the relationships between the coronal pelvic tilt and coronal alignment in DLS. Methods One hundred and sixty‐one DLS patients in our hospital from May 2016 to December 2020 were reviewed and documented. The coronal balance distance (CBD, the offset between the center of C7 and the plumb line drawn from the center of S1), major Cobb (MC), fractional Cobb (FC), L4 coronal tilt, L5 coronal tilt, coronal pelvic tilt, apical rotation, and the vertebras in major curve were measured and documented. CM was considered if the CBD ≥ 30mm. All of those participants were assigned into group A (CBD ≥ 30 mm) and group B (CBD < 30 mm). Comparisons of demographic and radiographic data were performed between groups A and B. Pearson correlation and further multiple regression with stepwise method analysis were used to investigate those coronal parameters correlated to MC and CBD, respectively. Results Thirty‐one patients suffering from CM were assigned into group A, and the rest of 130 patients were assigned to group B accordingly. Then the incidence of CM was about 19.3% (31/161). Patients in group A had less vertebras in the main curve (P = 0.009), however, the apical rotation (P < 0.001) and the L4 coronal tilt (P = 0.007) were much larger. Although the MC (P = 0.426) and FC (P = 0.06) had no difference between the two groups, the match between MC and FC was much smaller (p = 0.021) in group A. The coronal pelvic tilt correlated significantly with FC (r = 0.552, p < 0.001), but mildly with MC (r = −0.366, p < 0.001), L4 coronal tilt (r = 0.348, p < 0.001), and L5 coronal tilt (r = 0.351, p < 0.001), respectively. The CBD correlated strongly with L4 coronal tilt (r = −0.471, p < 0.001) and L5 coronal tilt (r = −0.468, p < 0.001), respectively, but mildly with FC (r = −0.255, p = 0.016). Further multiple regression analysis revealed that only L4 coronal tilt was the independent factor for MC (r2 = 0.549, p < 0.001) and CBD (r2 = 0.221, p < 0.001), respectively. Conclusions The prevalence of CM in DLS patients is about 19% at pre‐operation. With similar major Cobb, the less the vertebras in the major curve, the larger the CBD. L4 coronal tilt may correlate significantly to scoliosis and CBD. Coronal pelvic tilt may be just one of the compensations for the scoliosis deformity but effects CBD directly.
Collapse
Affiliation(s)
- Zifang Zhang
- The Spinal Surgery Department of the Affiliated Hospital of Jining Medical University, Jining, China.,The Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Tao Liu
- The Department of Orthopaedics, Yanzhou Branch of Affiliated Hospital of Jining Medial University, Jining, China
| | - Yan Wang
- The Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Zheng Wang
- The Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Guoquan Zheng
- The Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
10
|
Asymmetrical thoracic-lumbar coordination during trunk rotation between adolescents with and without thoracic idiopathic scoliosis. Spine Deform 2022; 10:783-790. [PMID: 35175573 DOI: 10.1007/s43390-022-00483-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
STUDY DESIGN Cross-sectional comparative study. PURPOSE To compare thoracic-lumbar kinematic changes and coordination based on coupling angles (CAs) in two different directions of trunk rotation between adolescents with idiopathic scoliosis (AIS) and control subjects. Altered three-dimensional (3D) deviations are often apparent in AIS groups during functional activities, such as gait. However, there is a lack of consistent evidence on coordinated motions during different directions of trunk rotation. METHODS This study included 14 AIS and 17 age-matched control subjects who were all right limb dominant. A motion capture system was utilized to analyze the spinal segment motions. The outcome measures included range of motion (ROM) at the first thoracic (T1), seventh thoracic (T7), and first lumbar (L1) spinous processes as well as the sacral tubercle (S1). The CAs compared in-phase (rotation from right to left) and anti-phase (rotation from left to right) trunk rotations. RESULTS Although there was no significant association with the spinal segments in the control group, the Cobb angle demonstrated significant positive correlations with anti-phase at T7 and L1 as well as in-phase at L1. Regarding the CAs, the groups demonstrated a significant interaction with both phases (F = 4.7, p = 0.04). The AIS group demonstrated positive correlations with ROM during in-phase at L1 and anti-phase at T7 and L1. CONCLUSION The coordination based on the CAs of the lumbar spine relative to the thoracic spine significantly decreased during left to right trunk rotation in the AIS group. These results indicated that the AIS group demonstrated directional dissociation toward the dominant side of lumbar rotation. LEVEL OF EVIDENCE III.
Collapse
|
11
|
Bortz C, Williamson T, Adenwalla A, Naessig S, Imbo B, Passfall L, Krol O, Tretiakov P, Joujon-Roche R, Moattari K, Sagoo N, Ahmad S, Singh V, Owusu-Sarpong S, Vira S, Diebo B, Passias PG. The Prevalence of Hip Pathologies in Adolescent Idiopathic Scoliosis. J Orthop 2022; 31:29-32. [PMID: 35360471 PMCID: PMC8961074 DOI: 10.1016/j.jor.2022.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/14/2022] [Indexed: 10/18/2022] Open
Abstract
Background Adolescent idiopathic scoliosis (AIS) is the most common form of abnormal spine curvature observed in patients age 10 to 18. Typically characterized by shoulder height and waistline asymmetry, AIS may drive uneven distribution of force in the hips, leading to increased rates of concurrent hip diagnoses. The relationship between AIS and concurrent hip diagnoses is underexplored in the literature, and to date, there has been little research comparing rates of hip diagnoses between patients with AIS and those unaffected. Purpose Assess differences in rates and clusters of hip diagnoses between patients with AIS and those unaffected. Study design Retrospective review of Healthcare Cost and Utilization Project's (HCUP) Nationwide Inpatient Sample (NIS). Patient sample 224,504 weighted inpatient discharges. Outcome measures Rates of hip diagnoses. Methods Patients in the NIS database (2005-2013) ages 10-18 years were isolated. Patients were grouped by those diagnosed with AIS (ICD-9: 737.30) and those unaffected. Patient groups were propensity score matched (PSM) for age. Means comparison tests assessed differences in demographic, comorbidity, and diagnosis profiles between patient groups for corresponding age categories. ICD-9 codes were used to identify specific hip diagnoses. Results Following PSM, 24,656 AIS and 24,656 unaffected patients were included. The AIS patient group was comprised of more females (66% vs 59%) and had lower rates of obesity (2.4% vs 3.5%, both p < 0.001). Overall, 1.1% of patients had at least one hip diagnosis: congenital deformity (0.31%), developmental dysplasia (0.24%), recurrent dislocation (0.18%), isolated dislocation (0.09%), osteonecrosis (0.08%), osteochondrosis (0.07%), acquired deformity (0.03%), and osteoarthritis (0.02%). AIS patients had lower rates of osteonecrosis (0.04% vs 0.12%, p = 0.003), but higher rates of all other hip diagnoses, including dysplasia (0.41% vs 0.07%, p < 0.001), recurrent dislocation (0.32% vs 0.03%, p < 0.001), isolated dislocation (0.13% vs 0.06%, p < 0.001), and osteoarthritis (0.04% vs 0.01%, p = 0.084. Co-occurrences of hip diagnoses were relatively rare, with 0.03% patients having more than one hip diagnosis. Rates of co-occurring hip diagnoses did not differ between AIS and unaffected groups (0.04% vs 0.02%, p = 0.225). Conclusions Compared to unaffected patients of similar ages, patients with AIS had higher overall rates of hip diagnoses, including dysplasia and recurrent dislocation. A higher trend of precocious osteoarthritis was also observed at a higher rate in AIS patients, although this difference was not statistically significant. Our results present an argument for surgical realignment in the coronal and sagittal planes to neutralize asymmetrical forces in the hips, and suggest the need for increased awareness and clinical screening for hip-related disorders in AIS patients. Level of Evidence III.
Collapse
|
12
|
Mehkri Y, Hernandez J, McQuerry JL, Carmona J, Ihnow S. Global Spine Range of Motion in Patients With Adolescent Idiopathic Scoliosis Before and After Corrective Surgery. Cureus 2021; 13:e19362. [PMID: 34909319 PMCID: PMC8653949 DOI: 10.7759/cureus.19362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 12/16/2022] Open
Abstract
Given the importance of the spine in carrying out daily movements, adolescent idiopathic scoliosis (AIS) can significantly limit the range of motion (ROM). Severe forms of AIS are treated surgically, most commonly with posterior spinal fusion and instrumentation, which may also reduce spine ROM. This review is the first to describe the literature on total spine ROM in patients with AIS before and after corrective surgery. A systematic literature search was performed using PubMed and Google Scholar to identify articles reporting global spine ROM in AIS patients. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 486 articles were initially identified. Two independent reviewers (YM and JH) assessed eligibility for inclusion. A total of 11 articles fit the inclusion criteria. AIS in untreated patients seems to limit axial and coronal plane ROM based on the degree of curve severity, with more severe curves having less ROM. More research comparing total spine ROM in untreated AIS patients to that of healthy controls is needed. In those undergoing spinal fusions, the lowest instrumented vertebra and surgical approach appear to minimize further reductions in ROM; however, the findings are mixed. Vertebral body tethering (VBT) shows promising preliminary results in treating AIS while preserving motion; however, long-term outcomes have yet to be assessed for this novel procedure. The results of this systematic review suggest that further research is required before treatment strategies can be modified for surgically treating patients with AIS to take into account the effects of treatment on changes in spine mobility.
Collapse
Affiliation(s)
- Yusuf Mehkri
- Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Jairo Hernandez
- Surgery, University of Florida College of Medicine, Gainesville, USA
| | - Jessica L McQuerry
- Pediatric Orthopaedics, University of Florida College of Medicine, Gainesville, USA
| | - Johanna Carmona
- Pediatric Orthopaedics, University of Florida College of Medicine, Gainesville, USA
| | - Stephanie Ihnow
- Pediatric Orthopaedics, University of Florida College of Medicine, Gainesville, USA
| |
Collapse
|