The Idiopathic Scoliosis and Its Treatment (Orthopaedic and Surgery): Effect of the Severity, the Orthosis and the Arthrodesis on the Gait
The Idiopathic Scoliosis and Its Treatment (Orthopaedic and Surgery): Effect of the Severity, the Orthosis and the Arthrodesis on the Gait
The purposes of this study were as follows: 1) to compare locomotion parameters (kinematic,
 EMG, mechanical work and energy cost changes during walking in able-bodied subjects and AIS
 patients,2) to evaluate the effects of the frontal curve's severity of the AIS and 3) the
 effects of the treatment (orthosis or surgery)on these gait parameters.
Introduction X-ray studies and three-dimensional analysis in standing showed that this
 Adolescent Idiopathic Scoliosis was characterised by stiffness of the affected vertebral
 levels [3, 7, 10] with decreased segmental mobilities. The impact of this stiffness was
 studied during functional activity such as walking to quantify the functional dynamic
 consequences. During gait, thoracic AIS provided an asymmetrical trunk rotation with a lack
 of rotation on the convex side [8] and an excessive paravertebral muscular bilateral activity
 [11]. These studies included only moderate scoliosis. There were no studies approaching the
 effects of the severity of the scoliosis curves on gait parameters.

 We hypothesize first that, the spinal deformations in AIS, producing a stiffness of the
 trunk, pelvic and hip motions, will deteriorate the gait by reducing the segmental
 mobilities, increasing the mechanical work and the energy cost and second that the severity
 of the frontal curves will be more damaging on this parameters. To this end, we hope to gain
 valuable insight as to the functional effects of the scoliosis aggravation from a more
 dynamic perspective.

 Material Fifty-four female adolescents will be included in the study. This sample consists in
 two groups: healthy girls and girls with adolescent idiopathic scoliosis (divided in 3
 subgroups according to the Cobb angle range) [9].

 A standard full spine XRay assessment will be performed to measure the Cobb angle curve, the
 frontal body balance, the apical vertebral rotation [13].

 Gait will be assessed by a three-dimensional analysis, including synchronous kinematic [4],
 electromyographic (EMG) [14], mechanic [5, 6, 15] and energetic measurements [1, 2, 12].

 The sessions begins with a rest period, in which the subjects stand barefoot on the motor
 driven treadmill for the static calibration of kinematic and energetic variables. Thereafter,
 the subjects will be asked to walk at a constant speed of 4 km h-1 for a few minutes until a
 steady state will be reached and maintained for at least two minutes. Then, energetic
 variables will be computed for two minutes. Other variables will simultaneously be recorded
 for twenty seconds and averaged for ten successive strides. The mean of each value will be
 used for statistical analysis. Scoliosis patients will be assessed at T0 i.e. before any
 treatment and at T1 i.e. one year after the starting of the orthosis wearing (scoliosis
 subgroup 2) or the surgery (scoliosis subgroup 3)
Inclusion Criteria:

 -  healthy subjects : no scoliosis diagnosed

 -  Scoliosis subjects : scoliosis diagnosed by X-Ray assessment

 Exclusion Criteria:

 -  Patients with leg length discrepancies higher than 1 cm, any locomotor disorders, low
 back pain, neurological abnormalities observed on clinical examination or with any
 previous treatment for their scoliosis