Surgery for Adult Spinal Deformity Improves Gait Patterns, but Limitations Remain

Lead author Mitsuru Yagi, MD, PhD, and Harel Deutsch, MD, comment

Surgical correction of adult spinal deformity (ASD) was linked to improvements in gait patterns, but patients still show asymmetric gait patterns compared with health controls, according to findings from a prospective case series in the March issue of The Spine Journal.

“Corrective spine surgery improved the gait ability and gait pattern in adult spinal deformity patients,” lead author Mitsuru Yagi, MD, PhD, told SpineUniverse. “But even after the improvement of ROM [range of motion] of hip and knee and spinal tilting during gait, when comparing to the healthy volunteers, the patients’ gait velocity is still low.”
A group of people using nordic style walkers“This suggests that long lasting low ADL [activities of daily living] might weaken the lower extremity muscles, and therefore, patients cannot walk fast,” said Dr. Yagi, who is Assistant Professor in the Department of Orthopedic Surgery at Keio University School of Medicine in Tokyo, Japan.

Gait Compared Pre- and Postoperatively
Dr. Yagi and colleagues examined the gait patterns of 33 consecutive women with ASD (mean age, 67.1 years) before and at least 2 years after corrective surgery. The data was compared with a group of 33 age- and gender-matched healthy controls.

Preoperatively, the women with ASD had a significantly worse gait velocity and stride compared with the control group. The following factors significantly correlated with preoperative gait velocity and stride: hip, knee, and ankle range of motion (ROM); gravity line; spinopelvic alignment; Cobb angle; trunk shift; and lean volume of the lower leg.

Patients in the ASD group also showed significantly impaired hip range of motion as well as right and left ground reaction force vectors preoperatively.

After surgery, while gait velocity and stride improved significantly in the ASD group, these measures were remained impairment compared with the control group (Table). Spinal alignment and ROM of the ankle and knee improved in the ASD group following surgery, while hip ROM remained impaired compared with the control group.
Table. Gait Patterns Before and After Corrective Surgery in Patients with Adult Spinal Deformity (n=33) Compared With Healthy  Preoperative and Postoperative Exercises May Improve Gait
“Most of the elderly patients said they ‘can walk without pain, but cannot walk with my friend because I walk slightly slow,’” Dr. Yagi said. “The pre-op and postop exercise probably improved the gait velocity of those who had corrective spine surgery for the treatment of ASD.”

Patient satisfaction was moderately correlated with gait velocity (r=0.34), suggesting the importance of incorporating gait analysis into the evaluation and treatment of this patient population, the study authors noted.

“The studies propose that people with ASD have impaired gait, which is intuitive,” commented Harel Deutsch, MD, Associate Professor of Neurosurgery, Rush University Medical Center, in Chicago. “The study also suggests that the impaired gait is more than a function of pain with walking, but rather is a mechanical disturbance due to posture.”

“The study does at times conflate coronal scoliosis sagittal balance,” Dr. Deutsch said. “It is unclear if patients had coronal vs sagittal imbalance since only averages are given for the patients. Is the gait issue more pronounced in patients with sagittal deformity versus coronal deformity? While the study says that improvements in gait velocity are not related to pain, it doesn’t seem like pain is analyzed.”

Updated on: 10/10/17
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