Hip loading asymmetry in Lenke type 1 idiopathic scoliosis: Effect of spinal fusion and sex

Abstract

BackgroundThoracic curvatures are most common in patients with idiopathic scoliosis. The literature highlights an imbalance of hip joint moments in the frontal plane quantified with a symmetry index. Spinal arthrodesis can reduce this symmetry index which then tends towards 0. Furthermore, asymptomatic women present lower hip moment in the frontal plane than asymptomatic men. This difference could influence the symmetry index in the case of patients with idiopathic scoliosis. Therefore, the main objective of this study was to show a significant positive effect of spinal arthrodesis on the symmetry index. The secondary objective was to compare the symmetry index between sexes before spinal fusion. MethodThe retrospective study included 20 patients with Type-1 Lenke curve idiopathic scoliosis, who performed a gait analysis before and one year after spinal fusion. The gait analysis consisted of walking back and forth at spontaneous speed. FindingsWhile significantly lower curvatures were depicted, the symmetry index showed a significantly lower value after spinal fusion (p < 0.03). The symmetry index showed no significant difference between sexes (p > 0.05). InterpretationThe study shows the effect of surgical fusion on the symmetry index, although the latter remains significant compared to the norm. Literature reveals that spinal fusion tends to the symmetrisation of the body's center of mass and increases ranges of motion on the trunk and pelvis. This could favour symmetry of hip moment in the frontal plane. Future research should investigate other Type Lenke curves before and after surgery, and the effect of braces on this symmetry index.