Use of a Triaxial Accelerometer to Measure Changes in Gait Sway and Related Motor Function after Corrective Spinal Fusion Surgery for Adult Spinal Deformity

Abstract

Background: Adult spinal deformity is a complex condition that causes lower back pain, causing spinal imbalance and discomfort in activities of daily life. After corrective spinal surgery, patients' gait and balance abilities might not revert to normalcy and they might be at increased risk of falling. Therefore, early evaluation of such a risk is imperative to prevent further complications such as a fall, or even worse, fractures in post-surgery ASD patients. However, there has been no report of an investigation of such early changes in gait sway before and after ASD surgery. This is a prospective to investigate changes in gait sway before and following ASD surgery, using accelerometers, and also to examine motor function related to postoperative gait sway. Methods: Twenty patients were included who underwent corrective surgery as treatment for ASD, from October 2019 to January 2023. Measurement parameters included a 10 m walking test and the timed up-and-go test (TUG), gait sway was evaluated using accelerometers (root mean square; RMS), and hip flexion and knee extension muscle strength were tested. RMS included RMS vertical: RMS_V; RMS anterior posterior: RMS_AP; RMS medial lateral: RMS_ML. The radiographic spinopelvic parameters were also evaluated preoperatively and postoperatively. p < 0.05 was noted as remarkably significant. Results: Preoperative and postoperative RMS_V were 1.07 ± 0.6 and 1.31 ± 0.8, respectively (p < 0.05). RMS_ML significantly decreased from 0.33 ± 0.2 to 0.19 ± 0.1 postoperatively (p < 0.01). However, RMS_AP did not change postoperatively (0.20 ± 0.2 vs. 0.14 ± 0.1, p > 0.05). Patients' one-month postoperative hip flexor muscle strength became significantly weaker (0.16 ± 0.04 vs. 0.10 ± 0.03 kgf/kg, p = 0.002), but TUG was maintained (11.6 ± 4.2 vs. 11.7 s, p = 0.305). RMS_V was negatively correlated with quadriceps muscle strength and positively with TUG. RMS_AP was negatively correlated with quadriceps muscle strength. All spinopelvic parameters became normal range after surgery. Conclusions: After corrective spinal fusion for ASD patients, the gait pattern improved significantly. Iliopsoas (hip flexor) and quadriceps femoris (knee extensor) muscles may play important roles for gait anterolateral and vertical swing, respectively.

Keywords: adult spinal deformity; gait sway; rehabilitation; spinal balance; surgery.

Figure 1

The principle of the accelerometer.

Figure 2

Patient selection.

Figure 3

61-year-old female, adult spinal deformity, L1-S1 OLIF and T10-pelvis posterior percutaneous fusion. (A): Preoperative posteroanterior radiogram, (B): preoperative lateral radiogram, (C): postoperative posteroanterior radiogram, (D): postoperative lateral radiogram.

Figure 4

Gait analysis.

Figure 5

Gait change before and after surgery.

Figure 6

Timed up-and-go test (TUG).

Figure 7

Spinopelvic parameter. SVA, sagittal vertical axis; PI, pelvic incidence; PT, pelvic tilt; LL, lumber lordosis; CSVL, center sacral vertical line.

Figure 8

Comparison of RMS_V before and after surgery.

Figure 9

Comparison of RMS_AP before and after surgery.

Figure 10

Comparison of RMS_ML before and after surgery.

Figure 11

The relationship between iliopsoas muscle stretching.