Preop Gait Comparisons Between Adult Lumbar Scoliotics and those with Able Bodies

Keith H. Bridwell, MD^,
Angela K. Reitenbach, MS~,
Mary L. Uhrich, MS~,
Lawrence G. Lenke, MD^,
Jack R. Engsberg, PHD^~
* (a – Scoliosis Research Society)
^Orthopaedic Surgery, Washington University School of Medicine,
~Human Performance Laboratory, Barnes–Jewish Hospital, St. Louis, MO, USA

INTRODUCTION:
Gait comparisons between patients with lumbar spinal deformity (scoliosis >50°, kyphosis ³0°) and able–bodied adults have never been reported.

PURPOSE:
To compare the gait of a group of adult lumbar deformity patients to a group of able–bodied adults.

METHODS:
13 female adults (age range 27–65) scheduled for deformity reconstruction had a preoperative gait analysis. Six female able–bodied adults with no spinal deformity or pathology (age range 39–58) served as controls. Thirty–six reflective surface markers were placed on a subject to create a 12–link segment model. A 6 camera video system recorded each subject as she walked along a 9 m walkway. Markers were tracked to produce 3D coordinates over the gait cycle. Gait speed and 3 motion variables were calculated. The motion variables described the orientation of the shoulders with respect to the pelvis. The first was the sagittal plane angular orientation of the shoulder segment with respect to the pelvis averaged over the entire gait cycle. The remaining variables were the coronal and transverse plane range of motion (ROM). Each subject also performed a graded exercise test (GXT) on a treadmill, where she walked until reaching 70% of her maximum heart rate. Unpaired t–tests were used to determine if a significant difference existed between the variables for the two groups (p<0.05). It was hypothesized that the deformity group would be significantly different (*) than the able–bodied group for all variables.

RESULTS:
Means (standard deviations) indicated that the preoperative surgical group walked slower, had their trunk inclined farther forward, displayed less range of motion in the coronal and transverse planes during the gait cycle, and walked for less time on the treadmill compared to able–bodied controls.

	Gait Speed	Sagittal Average	Coronal ROM	Transverse ROM	GXT
Group	(cm/s)	(deg)	(deg)	(deg)	(min)
Lumbar Deformity	85 (40)*	20 (11)*	7 (3)*	5 (3)*	7 (5)*
Able body	134 (19)	1 (10)	13 (4)	11 (4)	22 (6)

DISCUSSION: Objective data describing the function of adult lumbar deformity patients have not been previously reported. Results indicated that the patients were significantly more impaired than their able–bodied counterparts, walked for shorter distances, and at slower speeds. Future work will investigate changes in these variables as a consequence of the surgery.

This project has been funded in its entirety by the Scoliosis Research Society.
* If noted, the author indicates something of value received. The codes are identified as: a–research or institutional support, b–miscellaneous funding, c–royalties, d–stock options, e–consultant or employee.