Alteration of the Sitting and Standing Movement in Adult Spinal Deformity

Comparing Electromyographic Muscle Activities and Kinematics During Sit-to-Stand Transitions in Patients with Adult Spinal Deformity Versus Healthy Controls

Background/Objectives: Adult spinal deformity (ASD) affects sit-to-stand (STS) transitions due to abnormal spinal alignment, influencing muscle function. This study investigated lower-extremity electromyographic activity and kinematic parameters during STS transitions in ASD patients. Methods: A cross-sectional study was conducted with ASD patients scheduled for corrective surgery. The STS task was divided into three phases, and electromyographic activity, temporal parameters, and joint kinematics were compared between ASD patients and controls. Surface electromyography measured muscle activity, and a high-speed camera recorded phase durations and joint movements. Results: Compared to 17 controls, 17 ASD patients exhibited significantly increased %MVIC (ASD, controls, p-value) in the biceps femoris during the flexion momentum phase (23.7 ± 26.5, 12.3 ± 8.6, p = 0.048) and extension phase (48.6 ± 25.8, 32.8 ± 40.5, p = 0.011), and in the soleus during the flexion momentum phase (16.2 ± 7.5, 8.5 ± 2.9, p = 0.001). The ASD group also showed greater joint motion and longer phase durations during STS transitions. Conclusions: ASD patients display increased lower limb muscle activation, prolonged phase durations, and more joint motion during STS transitions. These findings highlight neuromuscular and biomechanical differences, though whether these are pathological, adaptive, or compensatory remains unclear.

Weak trunk extensors in adult spinal deformity patients are related to sagittal malalignment and kinematic limitations

BACKGROUND

Adult spinal deformity (ASD) is associated with muscles' degeneration that affects postural control and outcomes of an eventual corrective surgery. Evaluation of ASD is usually based on static radiographs and more recently on functional assessment. However, there has been limited exploration of muscle strength weakness in ASD. The aim was to investigate the relationship between trunk muscles' strength in ASD and its relationship with radiographic and kinematic alterations and quality-of-life decline.

METHODS

28 ASD and 18 asymptomatic subjects underwent biplanar radiographs with 3D calculation of spino-pelvic and global postural parameters. 3D movement analysis of gait, sitting to standing and stair ascent, was studied allowing the calculation of head, trunk and lower limbs 3D kinematics. Participants filled out health related quality of life questionnaires. A single operator measured 4 times the strength of the trunk muscles, using a hand-held dynamometer, to assess measurements' reliability. ASD population was divided into two groups based on the strength of trunk extensors: ASD-weak extensors (N = 11 patients having trunk extensors strength

RESULTS

Measurements of muscle strengths using the hand-held dynamometer were reliable (ICC>0.94). On standing radiographs, the ASD-weak extensors group showed an increased positive sagittal malalignment compared to the other groups (SVA=61 mm vs ASD-normal extensors: 18 mm, controls: -4 mm, p < 0.001). This sagittal malalignment remained during movement (kinematic-SVA=223 mm vs ASD-normal extensors:178 mm, controls:138 mm, p < 0.001). Muscle strength weakness was correlated to the decline of quality-of-life scores (PCS-SF36: r = 0.48, VAS for pain: ρ=-0.39).

CONCLUSIONS

This study showed that weak trunk extensors are associated with sagittal malalignment in static position, kinematic limitations during daily life activities and reduced quality of life scores. Future studies will investigate the effect of muscle strengthening on both static and dynamic alignment in ASD and their quality of life.

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Key Words

• 3D movement analysis
• Adult spinal deformity
• Functional assessment
• Muscle strength
• Trunk extensors

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MESH Headings

• Humans
• Male
• Female
• Biomechanical Phenomena
• Adult
• Quality of Life
• Torso/physiopathology
• Middle Aged
• Muscle Strength/physiology
• Case-Control Studies
• Radiography
• Spinal Curvatures/physiopathology
• Spinal Curvatures/diagnostic imaging
• Muscle Weakness/physiopathology
• Muscle, Skeletal/physiopathology
• Gait/physiology
• Young Adult

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Affiliation(s)

Maria Saadé Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Rami Rachkidi Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Ali Rteil Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Elma Ayoub Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Elena Jaber Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Celine Chaaya Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Nabil Nassim Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Elio Mekhael Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Rami Rehayem Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Julien Abi Nahed Technology Innovation Unit, Hamad Medical Corporation, Doha, Qatar
Bilal Ramadan Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Mohamad Karam Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Ismat Ghanem Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Abir Massaad Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Ayman Assi Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon; Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, Paris, France.

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Kinematic limitations during stair ascent and descent in patients with adult spinal deformity

Background

Adults with spinal deformity (ASD) are known to have spinal malalignment, which can impact their quality of life and their autonomy in daily life activities. Among these tasks, ascending and descending stairs is a common activity of daily life that might be affected.

Research question

What are the main kinematic alterations in ASD during stair ascent and descent?

Methods

112 primary ASD patients and 34 controls filled HRQoL questionnaires and underwent biplanar X-from which spino-pelvic radiographic parameters were calculated. Patients were divided into 3 groups: 44 with sagittal malalignment (ASD-Sag: PT > 25°, SVA>5 cm or PI-LL>10°), 42 with isolated thoracic hyperkyphosis (ASD-HyperTK: TK > 60°), 26 with isolated frontal spine deformity (ASD-Front: Cobb>20°). All participants underwent 3D motion analysis of the whole body while ascending and descending a stair step from which kinematic waveforms were extracted.

Results

During stair ascent, ASD-Sag exhibited an increased thorax flexion (20 vs 5°), a decreased lumbar lordosis L1L3-L3L5 (7 vs 14°), and an increased ROM of lumbo-pelvic joint (15 vs 10°, all p < 0.05), compared to controls. Similar compensations were shown while descending the stairstep. ASD-HyperTK had similar kinematic limitations as ASD-Sag but to a lesser extent. ASD-Front had normal kinematic patterns. PCS-SF36 correlated to thorax flexion (r = -0.45) and ODI was correlated to pelvic tilt ROM (r = 0.46).

Discussion and conclusion

ASD subjects with sagittal malalignment tend to ascend and descend stairs with increased thorax flexion, making them more prone to falls. Compensation mechanisms occur at the head and lumbo-pelvic levels to maintain balance and avoid falling forward.

The relationship between static and dynamic postural deformities with pain and quality of life in non-athletic women

BACKGROUND

The assessment of the postural condition with functional tests are used with the least facilities in the shortest time, for a wide the range of movements for different parts of the body. Both static and dynamic posture measurements are predictive of injury. These two assessments provide different information regarding posture control. Also, with the advancement of this technology, the speed of posture assessment and deformity diagnosis can be increased and done with the minimum facilities. This can signal a new method for the quick diagnosis of abnormalities and ultimately prevent or correct psychological effects and musculoskeletal pain in the future. Because as seen according to the citations, abnormalities cause musculoskeletal pains, movement restrictions and ultimately affect the quality of life.

METHODS

The current research is of the applied and semi-experimental type, and in terms of the results it is of the relational and correlational type. In this research, 148 non-Athletic women from Fardis City participated, in which the results obtained from the static evaluation was analyzed by the Posture Screen application after taking photos from four directions using a smartphone, and also the dynamic evaluation was identified and analyzed by the researcher using the overhead squat test of compensatory movements, with the data that from Cornell pain and quality of life SF-36 questionnaires was. Data description and correlation between variables were done with the η coefficient method.

RESULTS

According to the findings there is a positive and significant correlation between the prevalence of uneven pelvic deformity and the amount of pain in non-athletic women (P = 0.036, η (148) = 0.17). In other words, pain increased significantly when the pelvis was changed from a normal position to a lateral deviation position. Also, there is a negative and significant relationship between the prevalence of deformity of knee movement, back arch, straight back, heel lift and the quality of life in non-athletic women (P = 0.020, η (148) = 0.19).

CONCLUSIONS

According to the results, deformities have an effect on pain and the frequency of pain, on the other hand, in the present study, dynamic evaluations showed deformities more accurately than static evaluations.

Global Sagittal Angle and T9-tilt seem to be the most clinically and functionally relevant global alignment parameters in patients with Adult Spinal Deformity

Introduction

Radiographic analysis is necessary for the assessment and the surgical planning in adults with spinal deformity (ASD). Restoration of global alignment is key to improving patient's quality of life. However, the large number of existing global alignment parameters can be confusing for surgeons.

Research question

To determine the most clinically and functionally relevant global alignment parameters in ASD.

Material and methods

ASD and controls underwent full body biplanar X-ray to calculate global alignment parameters: odontoid to hip axis angle (OD-HA), global sagittal angle (GSA), global tilt (GT), SVA, center of auditory meatus to hip axis (CAM-HA), SSA, T1-tilt and T9-tilt. All subjects filled HRQoL questionnaires: ODI, SF-36, VAS for pain and BDI (Beck's Depression Inventory). 3D gait analysis was performed to calculate kinematic and spatio-temporal parameters. A machine learning model predicted gait parameters and HRQoL scores from global alignment parameters.

Results

124 primary ASD and 47 controls were enrolled. T9 tilt predicted the most BDI (31%), hip flexion/extension during gait (36%), and double support time (39%). GSA predicted the most ODI (26%), thorax flexion/extension during gait (33%), and cadence (36%).

Discussion and conclusion

Among all global alignment parameters, GSA, evaluating both trunk shift and knee flexion, and T9 tilt, evaluating the shift of the center of mass, were the best predictors for most of HRQoL scores and gait kinematics. Therefore, we recommend using GSA and T9 tilt in clinical practice when evaluating ASD because they represent the most quality of life and functional kinematic of these patients.

ASD with high pelvic retroversion develop changes in their acetabular orientation during walking

Introduction

It was hypothesized that pelvic retroversion in Adult Spinal Deformity (ASD) can be related to an increased hip loading explaining the occurrence of hip-spine syndrome.

Research question

How pelvic retroversion can modify acetabular orientation in ASD during walking?

Methods

89 primary ASD and 37 controls underwent 3D gait analysis and full-body biplanar X-rays. Classic spinopelvic parameters were calculated from 3D skeletal reconstructions in addition to acetabular anteversion, abduction, tilt, and coverage. Then, 3D bones were registered on each gait frame to compute the dynamic value of the radiographic parameters during walking. ASD patients having a high PT were grouped as ASD-highPT, otherwise as ASD-normPT. Control group was divided in: C-aged and C-young, age matched to ASD-hightPT and ASD-normPT respectively.

Results

25/89 patients were classified as ASD-highPT having a radiographic PT of 31° (vs 12° in other groups, p ​< ​0.001). On static radiograph, ASD-highPT showed more severe postural malalignment than the other groups: ODHA ​= ​5°, L1L5 ​= ​17°, SVA ​= ​57.4 ​mm (vs 2°, 48° and 5 ​mm resp. in other groups,all p ​< ​0.001). During gait, ASD-highPT presented a higher dynamic pelvic retroversion of 30° (vs 15° in C-aged), along with a higher acetabular anteversion of 24° (vs 20°), external coverage of 38° (vs 29°) and a lower anterior coverage of 52° (vs 58°,all p ​< ​0.05).

Conclusion

ASD patients with severe pelvic retroversion showed an increased acetabular anteversion, external coverage and lower anterior coverage during gait. These changes in acetabular orientation, computed during walking, were shown to be related to hip osteoarthritis.

[Back-forward bending CT in simulated surgical position to evaluate the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture]

Objective

To introduce a scout view scanning technique of back-forward bending CT (BFB-CT) in simulated surgical position for evaluating the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture.

Methods

A total of 28 patients with thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture who met the selection criteria between June 2018 and December 2021 were included in the study. There were 6 males and 22 females with an average age of 69.5 years (range, 56-92 years). The injured vertebra were located at T 10-L 2, including 11 cases of single thoracic fracture, 11 cases of single lumbar fracture, and 6 cases of multiple thoracolumbar fractures. The disease duration ranged from 3 weeks to 36 months, with a median of 5 months. All patients received examinations of BFB-CT and standing lateral full-spine X-ray (SLFSX). The thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), local kyphosis of injured vertebra (LKIV), lumbar lordosis (LL), and the sagittal vertical axis (SVA) were measured. Referring to the calculation method of scoliosis flexibility, the kyphosis flexibility of thoracic, thoracolumbar, and injured vertebra were calculated respectively. The sagittal parameters measured by the two methods were compared, and the correlation of the parameters measured by the two methods was analyzed by Pearson correlation.

Results

Except LL ( P>0.05), TK, TLK, LKIV, and SVA measured by BFB-CT were significantly lower than those measured by SLFSX ( P<0.05). The flexibilities of thoracic, thoracolumbar, and injured vertebra were 34.1%±18.8%, 36.2%±13.8%, and 39.3%±18.6%, respectively. Correlation analysis showed that the sagittal parameters measured by the two methods were positively correlated ( P<0.001), and the correlation coefficients of TK, TLK, LKIV, and SVA were 0.900, 0.730, 0.700, and 0.680, respectively.

Conclusion

Thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture shows an excellent flexibility and BFB-CT in simulated surgical position can obtain the remaining real angle which need to be corrected surgically.

Cervical and thoracic/lumbar motion and muscle strength in surgically treated adolescent idiopathic scoliosis patients

BACKGROUND

To date, only one study assessed the spinal mobility and muscle strength of patients who were treated either with fusion or brace treatment.

OBJECTIVE

The aim of this retrospective study was to evaluate the range of motion (ROM) and strength of the cervical and thoracic/lumbar spine in patients who underwent spinal fusion for the treatment of adolescent idiopathic scoliosis (AIS) in comparison to healthy individuals.

METHODS

Patients (n= 28) who were treated surgically for AIS were included in the study. An age and gender matched control group (n= 22) was included that consisted of healthy individuals. DAVID® Lumbar/Thoracic Extension, Lumbar/Thoracic Rotation, and Cervical Extension/Lateral Flexion devices were used to measure cervical and lumbar/thoracic ROM as well as muscle strength.

RESULTS

Significant differences were observed between groups in all ROM measurements except thoracic/lumbar sagittal flexion ROM measurement (p= 0.198). There were significant differences between groups in terms of muscle strength, except thoracic lumbar left rotation strength (p= 0.081).

CONCLUSIONS

The findings of the current study demonstrated that cervical and thoracic/lumbar range of motion, as well as muscle strength, were significantly decreased in surgically treated adolescent idiopathic scoliosis patients compared to healthy counterparts. However, trunk (thoracic/lumbar) flexion range of motion and trunk left rotation muscle strength were not significantly different.