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Segi N, Nakashima H, Ito S, Ouchida J, Kayamoto A, Oishi R, Yamauchi I, Takegami Y, Ishizuka S, Seki T, Hasegawa Y, Imagama S. Is spinopelvic compensation associated with unstable gait?: Analysis using whole spine X-rays and a two-point accelerometer during gait in healthy adults. Gait Posture 2024; 111:22-29. [PMID: 38615565 DOI: 10.1016/j.gaitpost.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/29/2024] [Accepted: 04/10/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Pelvic incidence (PI)-lumbar lordosis (LL) mismatch has a significant destabilizing effect on the center of gravity sway in the static standing position. However, the association between spinopelvic alignment and balance during gait in healthy volunteers is poorly understood. RESEARCH QUESTION The degree of PI-LL mismatch and trunk anterior tilt in the static standing posture influences dynamic balance during gait. METHODS In this study, 131 healthy volunteers were divided into two groups: harmonious group (PI - LL ≤ 10°; n = 91) and unharmonious group (PI - LL > 10°; n = 40). A two-point accelerometer system was used for gait analysis; accelerometers were attached to the pelvis and upper trunk to measure acceleration in the forward-backward, right-left, and vertical directions so that sagittal (front-back) deviation width, coronal (right-left) width, and vertical width and their ratios were calculated. Measurements were compared between the two groups, and correlations between alignment and accelerometer data were examined. RESULTS The harmonious group showed a negative correlation between pelvic sagittal width and PI - LL, pelvic tilt (PT), and sagittal vertical axis (SVA) (correlation coefficient ρ = -0.42, -0.38, and -0.4, respectively), and a positive correlation between sagittal ratio and PI - LL (ρ = 0.35). The unharmonious group showed a positive correlation between pelvic sagittal width and PI and PT (ρ = 0.43 and 0.33, respectively) and between sagittal ratio and SVA (ρ = 0.32). The unharmonious group showed a positive correlation between upper trunk sagittal width and PI - LL and PT (ρ = 0.38 and 0.36, respectively). SIGNIFICANCE The association between spinal alignment and gait parameters differs depending on the presence or absence of PI-LL mismatch. The degree of pelvic compensation and trunk anterior tilt during static standing were associated with unstable gait balance.
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Affiliation(s)
- Naoki Segi
- Department of Orhopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan
| | - Hiroaki Nakashima
- Department of Orhopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan.
| | - Sadayuki Ito
- Department of Orhopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan
| | - Jun Ouchida
- Department of Orhopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan
| | - Azusa Kayamoto
- Department of Rehabilitation, Nagoya University Hospital,, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan
| | - Ryotaro Oishi
- Department of Orhopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan
| | - Ippei Yamauchi
- Department of Orhopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan
| | - Yasuhiko Takegami
- Department of Orhopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan
| | - Shinya Ishizuka
- Department of Orhopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan
| | - Taisuke Seki
- Department of Orthopedic Surgery, Aichi Medical University Medical Center, 17-33 Kawagoshi, Nikki, Okazaki, Aichi 444-2148, Japan
| | - Yukiharu Hasegawa
- Department of Rehabilitation, Kansai University of Welfare Sciences, 3-11-1, Asahigaoka, Kashiwara, Osaka 582-0026, Japan
| | - Shiro Imagama
- Department of Orhopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan
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Segi N, Nakashima H, Ito S, Ouchida J, Oishi R, Yamauchi I, Miyairi Y, Morita Y, Takegami Y, Ishizuka S, Seki T, Hasegawa Y, Imagama S. Do Postural and Walking Stabilities Change over a Decade by Aging? A Longitudinal Study. J Clin Med 2024; 13:1081. [PMID: 38398393 PMCID: PMC10889802 DOI: 10.3390/jcm13041081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Previous studies have demonstrated that the center of gravity (COG) is more unstable in the elderly than in young people. However, it is unclear whether aging itself destabilizes the COG. This study aimed to investigate changes in COG sway and gait kinematics over time by a longitudinal study of middle-aged and elderly adults. METHODS This study included 198 healthy middle-aged and elderly people who underwent stabilometry at ten-year intervals. The participants' mean age at baseline was 62.9 ± 6.5 years, and 77 (39%) of them were male. The results of stabilometry (mean velocity, sway area, postural sway center in the medial-lateral direction [X center], and postural sway center in the anterior-posterior direction [Y center]), and results of exercise tests (the height-adjusted maximum stride length [HMSL] and the 10 m walk test [10MWT]) were analyzed. The destabilized group with 11 participants, whose mean velocity exceeded 3 cm/s after 10 years, was compared with the stable group with 187 participants, whose mean velocity did not exceed 3 cm/s. RESULTS Mean velocity increased significantly over ten years (open-eye, from 1.53 ± 0.42 cm to 1.86 ± 0.67 cm, p < 0.001); however, the sway area did not change significantly. X center showed no significant change, whereas Y center showed a significant negative shift (open-eye, from -1.03 ± 1.28 cm to -1.60 ± 1.56 cm, p < 0.001). Although the results of 10MWT and initial HMSL did not differ significantly, the HMSL in the destabilized group at ten years was 0.64, which was significantly smaller than the 0.72 of others (p = 0.019). CONCLUSIONS The ten-year changes in COG sway in middle-aged and elderly adults were characterized by a significant increase in mean velocity but no significant difference in sway area. Because the destabilized group had significantly smaller HMSL at ten years, instability at the onset of movement is likely to be affected by COG instability.
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Affiliation(s)
- Naoki Segi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; (N.S.); (S.I.); (J.O.); (R.O.); (I.Y.); (Y.M.); (Y.M.); (Y.T.); (S.I.); (S.I.)
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; (N.S.); (S.I.); (J.O.); (R.O.); (I.Y.); (Y.M.); (Y.M.); (Y.T.); (S.I.); (S.I.)
| | - Sadayuki Ito
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; (N.S.); (S.I.); (J.O.); (R.O.); (I.Y.); (Y.M.); (Y.M.); (Y.T.); (S.I.); (S.I.)
| | - Jun Ouchida
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; (N.S.); (S.I.); (J.O.); (R.O.); (I.Y.); (Y.M.); (Y.M.); (Y.T.); (S.I.); (S.I.)
| | - Ryotaro Oishi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; (N.S.); (S.I.); (J.O.); (R.O.); (I.Y.); (Y.M.); (Y.M.); (Y.T.); (S.I.); (S.I.)
| | - Ippei Yamauchi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; (N.S.); (S.I.); (J.O.); (R.O.); (I.Y.); (Y.M.); (Y.M.); (Y.T.); (S.I.); (S.I.)
| | - Yuichi Miyairi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; (N.S.); (S.I.); (J.O.); (R.O.); (I.Y.); (Y.M.); (Y.M.); (Y.T.); (S.I.); (S.I.)
| | - Yoshinori Morita
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; (N.S.); (S.I.); (J.O.); (R.O.); (I.Y.); (Y.M.); (Y.M.); (Y.T.); (S.I.); (S.I.)
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; (N.S.); (S.I.); (J.O.); (R.O.); (I.Y.); (Y.M.); (Y.M.); (Y.T.); (S.I.); (S.I.)
| | - Shinya Ishizuka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; (N.S.); (S.I.); (J.O.); (R.O.); (I.Y.); (Y.M.); (Y.M.); (Y.T.); (S.I.); (S.I.)
| | - Taisuke Seki
- Department of Orthopedic Surgery, Aichi Medical University Medical Center, Nagakute 444-2148, Japan;
| | - Yukiharu Hasegawa
- Department of Rehabilitation, Kansai University of Welfare Sciences, Osaka 582-0026, Japan;
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; (N.S.); (S.I.); (J.O.); (R.O.); (I.Y.); (Y.M.); (Y.M.); (Y.T.); (S.I.); (S.I.)
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Early Postural Stability Changes in Patients Undergoing Correction of Spinal Deformity: A Prospective, Controlled Pilot Study. Spine (Phila Pa 1976) 2023; 48:240-246. [PMID: 36692155 DOI: 10.1097/brs.0000000000004527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/09/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND CONTEXT Adult spinal deformity (ASD) is a prevalent condition often requiring surgical intervention. Improved outcomes among ASD patients have been shown to correlate with postoperative spinopelvic parameters, yet little is currently known about the role of postural stability and balance assessment for ASD patients. PURPOSE Explore early changes in postural stability following ASD correction. STUDY DESIGN Prospective cohort study. PATIENT SAMPLE Sixteen adult patients who underwent four-level or greater posterolateral fusion to address global spinal malalignment and 14 healthy controls with no known spinal deformity nor surgery. OUTCOME MEASURES Postural stability parameters, spinopelvic parameters preoperatively and postoperatively. METHODS Force plate balance assessment was completed where participants and healthy controls were instructed to stand with their hands at their sides, standing still, with eyes open. Center of pressure (COP), center of gravity (COG), and cone of economy (COE) parameters were analyzed with paired and unpaired t tests with an alpha of 0.05. RESULTS Preoperatively, ASD patients demonstrated more COG (P=0.0244) and sagittal and coronal head (P<0.05) sway than healthy controls. Postoperatively, ASD patients exhibited less COP (P=0.0308), COG (P=0.0276) and head (P=0.0345) sway. Compared to healthy controls, ASD patients postoperatively exhibited similar postural stability, aside from COP and COG sway amplitudes (P<0.05), and coronal head sway (P=0.0309). Pelvic incidence-lumbar lordosis and sagittal vertical axis improved from 16.2° to 4.8° (P<0.01) and 82.2 to 22.5 mm (P<0.01), respectively. CONCLUSION We report a novel early improvement in postural stability, comparable to healthy controls, following ASD correction that may be related to improved spinopelvic alignment. Force plate evaluation may be a useful tool for ASD patients postoperatively. Future clinical trials assessing the impact of postural stability on clinical and radiographic outcomes are warranted.
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Cecilio FA, Siéssere S, Bettiol NB, Gauch CG, de Vasconcelos PB, Gonçalves LMN, Andrade LM, Regalo IH, Regalo SCH, Palinkas M. Effect of intervertebral disc degeneration on the stomatognathic system function in adults. Cranio 2022:1-9. [PMID: 36377796 DOI: 10.1080/08869634.2022.2144440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze the electromyographic activity (EMG) and thermographic patterns of the masseter and temporalis muscles and pressure of the orofacial tissues in individuals with intervertebral disc degeneration (IDD). METHODS This study had two distinct groups: with IDD (n = 16) and controls (n = 16). EMG at rest, protrusion, right and left laterality, and maximum voluntary contraction were evaluated. Tongue, orbicularis oris, and buccinator muscles pressures were measured by Iowa Oral Performance Instrument. The thermographic patterns were analyzed using infrared thermography. RESULTS Comparisons between groups showed significant differences regarding at rest [right (p = 0.05) and left (p = 0.05) masseter and right temporal (p = 0.05)], orofacial tissue pressure [tongue (p = 0.001), orbicularis oris (p = 0.01), and buccinator (p = 0.0001)], but no significant differences for the thermographic patterns. CONCLUSION IDD modifies the functionality of the craniomandibular complex, influencing the performance of the stomatognathic system.
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Affiliation(s)
- Flavia Argentato Cecilio
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Brazil
| | - Selma Siéssere
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Brazil
- Department of Neuroscience and Behavioral Sciences, National Institute of Science and Technology in Translational Medicine, São Paulo, Brazil
| | - Nicole Barbosa Bettiol
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Brazil
| | - Claire Genoveze Gauch
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Brazil
| | | | | | - Lilian Mendes Andrade
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Brazil
| | - Isabela Hallak Regalo
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Brazil
| | - Simone Cecilio Hallak Regalo
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Brazil
- Department of Neuroscience and Behavioral Sciences, National Institute of Science and Technology in Translational Medicine, São Paulo, Brazil
| | - Marcelo Palinkas
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Brazil
- Department of Neuroscience and Behavioral Sciences, National Institute of Science and Technology in Translational Medicine, São Paulo, Brazil
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Can Hip-Knee Line Angle Distinguish the Size of Pelvic Incidence?-Development of Quick Noninvasive Assessment Tool for Pelvic Incidence Classification. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031387. [PMID: 35162404 PMCID: PMC8834756 DOI: 10.3390/ijerph19031387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/07/2022] [Accepted: 01/22/2022] [Indexed: 02/04/2023]
Abstract
This study aimed to explore effective measurement angles for pelvic incidence (PI) classification and to develop a quick, noninvasive assessment tool for PI classification. We defined five variation types of hip–knee line (HKL) angles and tested the discrimination ability of the receiver operating characteristic (ROC) analysis using 125 photographs of upright standing posture from the right lateral side. ROC analysis revealed an applicable HKL angle defined by the line connecting the most raised part of the buttock and the central point of the knee and the midthigh line. The acceptable cut-off points for discriminating small or large PIs in terms of HKL angle were 18.5° for small PI (sensitivity, 0.91; specificity, 0.79) and 21.5° for large PI discrimination (sensitivity, 0.74; specificity, 0.72). In addition, we devised a quick noninvasive assessment tool for PI classification using the cut-offs of the HKL angle with a view to practical application. The results of intra- and inter-rater reliability ensured a substantial/moderate level of the tool (Cohen’s kappa coefficient, 0.79; Fleiss’s kappa coefficient, 0.50–0.54). These results revealed that the HKL angle can distinguish the size of the PI with a high/moderate discrimination ability. Furthermore, the tool indicated acceptable inter-/intra-rater reliability for practical applications.
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