Influence of Sagittal Imbalance of the Spine on Gait Pattern in Adult Spinal Deformity

Adult Spinal Deformity Clinical Trial

Official title:

Influence of Sagittal Imbalance of the Spine on Gait Pattern in Adult Spinal Deformity

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03304405
• Other study ID #: UW 16-294
• Status: Completed
• Start date: June 1, 2016
• Est. completion date: June 1, 2017

Study information

• Verified date: May 2020
• Source: The University of Hong Kong
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

This study intends to investigate the changes in gait pattern in adult spinal deformity (ASD) patients with sagittal imbalance. It will investigate the gait kinematics in patients who have a mismatch of their spinopelvic parameters, and a positive sagittal balance. The investigators hypothesise that patients with abnormal spinopelvic parameters may demonstrate a pathological gait pattern.

Description:

With an ageing population, ASD presents as a significant health issue with increasing incidence. Most of the earlier literature concentrated on radiographic measurements of the deformity in the coronal plane, and its surgical correction. However, recent publications have demonstrated that sagittal spinopelvic alignment plays a critical role in pain and disability in patients with ASD, and is a primary determinant of health related quality of life measures. There is substantial evidence that restoration of these parameters after spinal reconstructive surgery is correlated with good clinical outcome.

Maintenance of the ideal sagittal alignment allows an individual to maintain an erect posture with minimal energy expenditure. When there is progressive loss of lumbar lordosis, compensatory mechanisms involving the pelvis, hips and knees occur to extend adjacent segments of the kyphotic spine to allow for compensation of anterior translation of the axis of gravity. However, this compensatory mechanism may potentially result in adverse effect. One of the main disabilities in ASD patients with sagittal imbalance is their decreased walking tolerance. The change in the spinal alignment along with these compensatory mechanisms may result in an inefficient gait worsening their walking tolerance.

Few studies in the literature have investigated the changes in gait pattern in patients with sagittal imbalance. Of those, the patient group was heterogeneous, and the only criterion of sagittal imbalance was a positive sagittal vertical axis (SVA), which the investigators now know is not a complete assessment of the sagittal alignment. The investigators propose to study the change in gait pattern in individuals with abnormal spinopelvic parameters, and how this may affect their quality of lives.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 15
• Est. completion date: June 1, 2017
• Est. primary completion date: June 1, 2017
• Accepts healthy volunteers: No
• Gender: All
• Age group: N/A and older

Eligibility

Inclusion Criteria:

All patients diagnosed with ASD, fulfilling the following radiographic criteria based on whole spine lateral film are eligible for recruitment:

• SVA bigger than 47mm

• Pelvic tilt (PT) bigger than 22deg

• Pelvic incidence (PI) - lumbar lordosis (LL) bigger than 11deg

Exclusion Criteria:

• If the aetiology of the ASD of the patient is neuromuscular origin

• other pathologies that may affect their gait such as previous trauma or surgeries to the pelvis or the lower limbs and joint replacements

• inability to walk without aids for short distances

Related Conditions & MeSH terms

• Adult Spinal Deformity
• Congenital Abnormalities

Intervention

Diagnostic Test:
• Gait Analysis
All patients will undergo gait analysis using reflective surface markers placed at different locations on the head, trunk, upper and lower extremities, and pelvis. All patients will complete an analog pain scale, Oswestry, and SRS-22 questionnaires. These are health-related quality of life questionnaires that provide subjective assessment.

Locations

Country	Name	City	State
Hong Kong	Duchess of Kent Children's Hospital	Hong Kong

Sponsors (1)

Lead Sponsor	Collaborator
The University of Hong Kong

Country where clinical trial is conducted

Hong Kong, 

References & Publications (11)

Barrey C, Roussouly P, Le Huec JC, D'Acunzi G, Perrin G. Compensatory mechanisms contributing to keep the sagittal balance of the spine. Eur Spine J. 2013 Nov;22 Suppl 6:S834-41. doi: 10.1007/s00586-013-3030-z. Epub 2013 Sep 20. — View Citation

Cho KJ, Suk SI, Park SR, Kim JH, Kang SB, Kim HS, Oh SJ. Risk factors of sagittal decompensation after long posterior instrumentation and fusion for degenerative lumbar scoliosis. Spine (Phila Pa 1976). 2010 Aug 1;35(17):1595-601. doi: 10.1097/BRS.0b013e3181bdad89. — View Citation

Engsberg JR, Bridwell KH, Reitenbach AK, Uhrich ML, Baldus C, Blanke K, Lenke LG. Preoperative gait comparisons between adults undergoing long spinal deformity fusion surgery (thoracic to L4, L5, or sacrum) and controls. Spine (Phila Pa 1976). 2001 Sep 15;26(18):2020-8. — View Citation

Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976). 2005 Mar 15;30(6):682-8. — View Citation

Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976). 2005 Sep 15;30(18):2024-9. — View Citation

Gottipati P, Fatone S, Koski T, Sugrue PA, Ganju A. Crouch gait in persons with positive sagittal spine alignment resolves with surgery. Gait Posture. 2014;39(1):372-7. doi: 10.1016/j.gaitpost.2013.08.012. Epub 2013 Aug 18. — View Citation

Le Huec JC, Faundez A, Dominguez D, Hoffmeyer P, Aunoble S. Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review. Int Orthop. 2015 Jan;39(1):87-95. doi: 10.1007/s00264-014-2516-6. Epub 2014 Sep 6. Review. — View Citation

Romei M, Galli M, Motta F, Schwartz M, Crivellini M. Use of the normalcy index for the evaluation of gait pathology. Gait Posture. 2004 Feb;19(1):85-90. — View Citation

Sarwahi V, Boachie-Adjei O, Backus SI, Taira G. Characterization of gait function in patients with postsurgical sagittal (flatback) deformity: a prospective study of 21 patients. Spine (Phila Pa 1976). 2002 Nov 1;27(21):2328-37. — View Citation

Smith JS, Bess S, Shaffrey CI, Burton DC, Hart RA, Hostin R, Klineberg E; International Spine Study Group. Dynamic changes of the pelvis and spine are key to predicting postoperative sagittal alignment after pedicle subtraction osteotomy: a critical analysis of preoperative planning techniques. Spine (Phila Pa 1976). 2012 May 1;37(10):845-53. doi: 10.1097/BRS.0b013e31823b0892. — View Citation

Syczewska M, Dembowska-Baginska B, Perek-Polnik M, Kalinowska M, Perek D. Gait pathology assessed with Gillette Gait Index in patients after CNS tumour treatment. Gait Posture. 2010 Jul;32(3):358-62. doi: 10.1016/j.gaitpost.2010.06.006. Epub 2010 Jul 13. — View Citation

* Note: There are 11 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Evaluate the effect of sagittal imbalance on the gait cycle using reflective surface markers	To evaluate the effect of sagittal imbalance on the gait cycle using reflective surface markers	1 year
Secondary	Investigate the difference in gait kinematics between normal and abnormal sagittal balance using reflective surface markers	To investigate the difference in gait kinematics between normal and abnormal sagittal balance using reflective surface markers	1 year
Secondary	Investigate the efficiency in gait differences between normal and abnormal sagittal balance using reflective surface markers	To investigate the efficiency in gait differences between normal and abnormal sagittal balance using reflective surface markers	1 year
Secondary	Investigate different muscle recruitment in gait cycles between normal and abnormal sagittal balance using a submaximal graded exercise test	To investigate different muscle recruitment in gait cycles between normal and abnormal sagittal balance using a submaximal graded exercise test	1 year