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