Lower limb joint burden during walking in adolescent idiopathic scoliosis: investigation of mechanical work during walking

Can foot orthoses be an effective supplement to brace therapy for adolescent idiopathic scoliosis? A systematic review and meta-analysis of randomized controlled trials

BackgroundThe golden time for treatment of adolescent idiopathic scoliosis (AIS) is short, and how to effectively improve treatment outcomes to avoid surgery has been a focus of medical attention. Scoliosis orthoses are the preferred method of conservative treatment for AIS, but there are limitations in efficacy. Foot orthoses (FO) have gained traction in treating musculoskeletal disorders, potentially enhancing traditional brace therapy and offering renewed hope for AIS patients.ObjectiveThis study aimed to investigate whether a treatment regimen combined with FO would have a more positive impact on patients with AIS than using a scoliosis orthosis alone.MethodsPubMed, Web of Science, Embase, Cochrane Library, Scopus, CNKI, and Wanfang Data were searched for relevant randomized controlled trials (RCTs) published up to August 20, 2024. The risk of bias was assessed using the Cochrane Risk of Bias Tool. The quality of the outcomes was evaluated using the Grading, Assessment, Development, and Evaluation of Letters of Recommendation (GRADE). Statistical analyses were performed using Review Manager 5.3.ResultsCompared with scoliosis orthosis treatment alone, combined FO treatment significantly improved bilateral whole-foot pressure distribution（SMD = -0.38, 95% CI = [-0.70, -0.07], P = 0.02) and monopedal medial heel to lateral heel pressure ratio (M/L)（MD = -0.14, 95% CI = [-0.24, -0.04], P = 0.007), but failed to significantly improve the Cobb angle in patients with AIS（MD = -1.88, 95% CI = [-3.87, -0.10], P = 0.06) and the centre of pressure excursion index (CPEI)（MD = -1.36, 95% CI = [-2.85, -0.12], P = 0.07), also had no significant effect on quality of life. The RCTs exhibited a low risk of bias overall, with evidence quality ranging from low to moderate. No significant adverse effects were reported.ConclusionFO is a safe and effective intervention. Although its significant impact on improving the Cobb angle, CPEI, or quality of life was not definitively demonstrated, FO successfully optimised plantar pressure distribution and bilateral M/L balance. These improvements contribute to better static balance and postural stability in patients, suggesting FO as a promising complement to brace therapy.

Effects of spinal deformities on lower limb kinematics during walking: a systematic review and meta-analysis

Spinal deformities characterized by malalignment of the spinal column, including scoliosis, hyper kyphosis, and lordosis, can significantly impact lower limb kinematics, potentially leading to altered gait patterns. We aimed to synthesize existing literature investigating the effect of spinal deformities on lower limb kinematics during walking. We searched Four databases including PubMed, Web of Science, Scopus and Embase from their inception through 29th December 2024. The Newcastle-Ottawa Scale was applied to assess quality of included studies and the Grading of Recommendations Assessment, Development and Evaluation (GRADE system) was employed to assess the overall quality of the evidence in the meta-analysis. Mean differences and 95% confidence intervals (CI) were calculated with random effects model in RevMan version 5.4. The review included 35 studies with 1941 participants. Regarding scoliosis, strong evidence suggested a significant increase in right leg stance% and non-significant changes in left leg cadence, right and left leg speed and ankle transverse ROM in individuals with scoliosis compared to controls. Sensitivity analysis showed strong evidence of decrease in right leg stride length and ankle sagittal ROM, decrease in left leg single support and non-significant change in left leg step length. Individuals with sagittal malalignment showed strong evidence of significant reduction in velocity; moderate evidence suggested a significant increase in double support and a decrease in stride length, knee and hip sagittal ROM. Sensitivity analysis revealed strong evidence of a significant decrease in cadence during walking in individuals with sagittal trunk malalignment compared to controls. Participants with adult spinal deformity exhibited strong evidence of increased double support and decreased cadence during walking compared to controls. Spinal deformities significantly alter lower limb kinematics during gait. Our findings highlight the essential need for clinicians to take gait alterations into account when developing targeted interventions for individuals with spinal deformity.

Biomechanical analysis of trunk and lower limbs during stair activity in patients with scoliosis

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.

Effects of lower limb length discrepancy on spinopelvic compensation following total hip arthroplasty in patients with developmental dysplasia of the hip

BACKGROUND

Limited research has examined the impact of lower limb length discrepancy (LLLD) alteration on spinopelvic compensation in individuals with developmental dysplasia of the hip (DDH). This study aimed to investigate the effects of LLLD on spinopelvic compensation following total hip arthroplasty (THA) and elucidate the complex biomechanical adaptations in the spinopelvic structures.

METHODS

A retrospective review of DDH patients undergoing THA from January 2014 to December 2021 categorized individuals with Crowe type I and II into the low dislocation group (LDG, n = 94) and those with Crowe type III and IV into the high dislocation group (HDG, n = 43). Demographic data, as well as preoperative, postoperative, and last follow-up imaging data, including lower limb length (LLL), sacral obliquity (SO), iliac obliquity (IO), hip obliquity (HO), Cobb angle, apical vertebral translation (AVT), and coronal decompensation (CD), were collected for analysis.

RESULTS

Patients in the LDG had a significantly higher surgical age and shorter disease duration (P<0.05). In LDG, patients exhibited substantial postoperative reductions in LLLD, SO, IO, and HO (P<0.05), while Cobb Angle, AVT, and CD showed no statistically significant changes (P>0.05). The variation in LLLD correlated significantly with the variations in SO, IO, and HO (P<0.05). Postoperative outcomes in the HDG demonstrated marked decreases in LLLD, SO, IO, HO, and CD (P<0.05), with no significant change in Cobb angle and AVT (P>0.05). The variation in LLLD correlated significantly with the variations in SO, IO, HO, and CD (P<0.05).

CONCLUSIONS

THA effectively reduces LLLD in patients with DDH, and the variation in LLLD correlates meaningfully with the recovery of spinopelvic compensatory mechanisms.

Can external work during walking in scoliosis patients be estimated from spatiotemporal parameters?

BACKGROUND

Patients with scoliosis present gait impairments compared to healthy subjects. Clinically, spine deformity is evaluated with Cobb angle, a standard measurement to determine and track the progression of scoliosis. Scoliosis is a biomechanical trouble, dependant of external forces and muscular activity. External work is currently analyzed in patients with scoliosis because this work sums up consequences and evolutions of spine deformity. Habitually, biomechanics approach is used to compute this work. For asymptomatic subjects, a regression model let to compute external work. So, considering the area of research to facilitate the follow-up at lower cost, this regression function could be applied to patients with scoliosis but need to be validated.

RESEARCH QUESTION

can external work during walking in scoliosis patients be estimated from spatiotemporal parameters with a regression model?

METHOD

This retrospective study included twenty untreated patients with idiopathic scoliosis and sixteen asymptomatic participants. We used a regression model defined in case of asymptomatic subjects in literature and proposed a new specific model in case of patients with scoliosis.

FINDINGS

The external work in patients with scoliosis calculated with the Wirta's regression eq. (0.23 ± 0.04 J.kg-1.m-1) was underestimated compared to the external work calculated using a biomechanical method (0.33 ± 0.06 J.kg-1.m-1). A new regression model including Cobb angle and spatio-temporal parameter presents a high coefficient of determination.

INTERPRETATION

In opposition to biomechanical method, our new model let to compute external work without expensive gait laboratory. This specific model is more reliable than the model developed from asymptomatic subjects.