Quantifying the Contribution of Lower Limb Compensation to Upright Posture: What Happens If Adult Spinal Deformity Patients Do Not Compensate?

Female Humans Adult Aged Middle Aged Male Quality of Life Prospective Studies Spine Lower Extremity / surgery Posture Retrospective Studies

Journal

Spine

ISSN: 1528-1159

Titre abrégé: Spine (Phila Pa 1976)

Pays: United States

ID NLM: 7610646

Informations de publication

Date de publication:
01 Aug 2023

Historique:

received: 27 09 2022

accepted: 03 01 2023

medline: 19 7 2023

pubmed: 28 3 2023

entrez: 27 3 2023

Statut: ppublish

Résumé

This is a multicenter, prospective cohort study. This study tests the hypothesis that the elimination of lower limb compensation in patients with adult spinal deformity (ASD) will significantly increase the magnitude of sagittal malalignment. ASD affects a significant proportion of the elderly population, impairing functional sagittal alignment and inhibiting the overall quality of life. To counteract these effects, patients with ASD use their spine, pelvis, and lower limbs to create a compensatory posture that allows for standing and mobility. However, the degree to which each of the hips, knees, and ankles contributes to these compensatory mechanisms has yet to be determined. Patients undergoing corrective surgery for ASD were included if they met at least one of the following criteria: complex surgical procedure, geriatric deformity surgery, or severe radiographic deformity. Preoperative full-body x-rays were evaluated, and age and pelvic incidence -adjusted normative values were used to model spine alignment based upon three positions: compensated (all lower extremity compensatory mechanisms maintained), partially compensated (removal of ankle dorsiflexion and knee flexion, with maintained hip extension), and uncompensated (ankle, knee, and hip compensation set to the age and pelvic incidence norms). A total of 288 patients were included (mean age 60 yr, 70.5% females). As the model transitioned from the compensated to uncompensated position, the initial posterior translation of the pelvis decreased significantly to an anterior translation versus the ankle (P.Shift: 30 to -7.6 mm). This was associated with a decrease in pelvic retroversion (pelvic tilt: 24.1-16.1), hip extension (SFA: 203-200), knee flexion (knee angle: 5.5-0.4), and ankle dorsiflexion (ankle angle: 5.3-3.7). As a result, the anterior malalignment of the trunk significantly increased: sagittal vertical axis (65-120 mm) and G-SVA (C7-ankle from 36 to 127 mm). Removal of lower limbs compensation revealed an unsustainable truncal malalignment with two-fold greater SVA.

Sections du résumé

STUDY DESIGN METHODS

This is a multicenter, prospective cohort study.

OBJECTIVE OBJECTIVE

This study tests the hypothesis that the elimination of lower limb compensation in patients with adult spinal deformity (ASD) will significantly increase the magnitude of sagittal malalignment.

SUMMARY OF BACKGROUND DATA BACKGROUND

ASD affects a significant proportion of the elderly population, impairing functional sagittal alignment and inhibiting the overall quality of life. To counteract these effects, patients with ASD use their spine, pelvis, and lower limbs to create a compensatory posture that allows for standing and mobility. However, the degree to which each of the hips, knees, and ankles contributes to these compensatory mechanisms has yet to be determined.

METHODS METHODS

Patients undergoing corrective surgery for ASD were included if they met at least one of the following criteria: complex surgical procedure, geriatric deformity surgery, or severe radiographic deformity. Preoperative full-body x-rays were evaluated, and age and pelvic incidence -adjusted normative values were used to model spine alignment based upon three positions: compensated (all lower extremity compensatory mechanisms maintained), partially compensated (removal of ankle dorsiflexion and knee flexion, with maintained hip extension), and uncompensated (ankle, knee, and hip compensation set to the age and pelvic incidence norms).

RESULTS RESULTS

A total of 288 patients were included (mean age 60 yr, 70.5% females). As the model transitioned from the compensated to uncompensated position, the initial posterior translation of the pelvis decreased significantly to an anterior translation versus the ankle (P.Shift: 30 to -7.6 mm). This was associated with a decrease in pelvic retroversion (pelvic tilt: 24.1-16.1), hip extension (SFA: 203-200), knee flexion (knee angle: 5.5-0.4), and ankle dorsiflexion (ankle angle: 5.3-3.7). As a result, the anterior malalignment of the trunk significantly increased: sagittal vertical axis (65-120 mm) and G-SVA (C7-ankle from 36 to 127 mm).

CONCLUSIONS CONCLUSIONS

Removal of lower limbs compensation revealed an unsustainable truncal malalignment with two-fold greater SVA.

Identifiants

DOI: 10.1097/BRS.0000000000004646 PMID: 36972137

pubmed: 36972137

doi: 10.1097/BRS.0000000000004646

pii: 00007632-990000000-00273

doi:

Types de publication

Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

1082-1088

Informations de copyright

Déclaration de conflit d'intérêts

The authors report no conflicts of interest.

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