Correlational analysis of three-dimensional spinopelvic parameters with standing balance and gait characteristics in adolescent idiopathic scoliosis: A preliminary research on Lenke V

Abstract

Background: Adolescent idiopathic scoliosis (AIS), the most common spinal deformity, possibly develops due to imbalanced spinal loading following asymmetric development. Since altered loading patterns may affect standing balance and gait, we investigated whether a correlation exists between balance ability, gait pattern, and the three-dimensional radiographic spinopelvic parameters in AIS patients. Methods: A cross-sectional observational study was conducted with 34 AIS patients (aged 10-18 years) and an equal number of healthy age and sex-matched teenagers (normal group). We obtained the spinopelvic three-dimensional parameters and balance parameters simultaneously through the EOS imaging system and gait and center of pressure (CoP) characteristics using a plantar pressure measurement mat. Besides determining the intergroup differences in balance and gait parameters, multiple linear regression analyses were performed to identify any correlation between the static plantar pressure and radiographic parameters. Results: Compared to the normal group, the CoP_x is lower, the CoP path length and 90% confidence ellipse area were significantly higher in AIS patients (AIS: -13.7 ± 5.7 mm, 147.4 ± 58.1 mm, 150.5 ± 62.8 mm²; normal: -7.0 ± 5.4 mm, 78.8 ± 32.0 mm, 92.1 ± 41.7 mm², respectively), correlated with apical vertebra translation, sagittal pelvic tilt, and pelvis axial rotation, respectively. Moreover, AIS patients had a shorter stance phase (61.35 ± 0.97 s vs. 62.39 ± 1.09 s), a longer swing phase (38.66 ± 0.97 s vs. 37.62 ± 1.08 s), and smaller maximum pressure peaks in the gait cycle, especially on the left foot, as compared to healthy subjects. Moreover, the CoP trajectory in AIS patients was different from the latter, and changes in the bipedal trend were not consistent. Conclusion: The standing balance and gait characteristics of AIS patients are different from those of healthy subjects, as reflected in their three-dimensional spinopelvic radiographic parameters. Trial registration: The study protocol was registered with the Chinese Clinical Trial Registry (Number ChCTR1800018310) and the Human Subject Committee of Guangzhou Sport University (Number: 2018LCLL003).

Keywords: 3d parameters; adolescent idiopathic scoliosis; correlation analysis; gait; standing balance.

FIGURE 1

Scoliosis screening methods-(A) Adam’s test and trunk rotation angle measured with a Scoliometer; (B) A radiation-free spine ultrasound imaging system; (C) Ultrasound imaging.

FIGURE 2

(A) is a Patient undergoing EOS imaging while his balance data is collected. (B) and (C) are the full 3-D recondtruction images of the spine performed by the radiologist using a post-processing software of EOS. (D) shows the gaint information of a patient being collected.

FIGURE 3

Statistically significant relationships between static balance and radiographic parameters. CoP: center of pressure; CoPx: the mean mediolateral CoP position; AVT: apical vertebra translation; PT: Sagittal pelvic tilt.

FIGURE 4

Bipedal maximum pressure curves of the two groups during gait cycle.Red indicates Adolesce Idiopathic Scoliosis (AIS) group and Blue indicates normal group. The solid line indicates th maximum pressure curve, and the shaded area is the standard deviation. Expect for the first peak of the right foot, the peak value of AIS group is lower than that of the normal group.

FIGURE 5

The gait line in Adolescent Idiopathic Scoliosis (AIS) and normal groups.Obviously ,the two groups are different, and bipedal asymmetry and Inconsistent change trend.