Influence of spino-pelvic and postural alignment parameters on gait kinematics

Abstract

IntroductionPostural alignment is altered with spine deformities that might occur with age. Alteration of spino-pelvic and postural alignment parameters are known to affect daily life activities such as gait. It is still unknown how spino-pelvic and postural alignment parameters are related to gait kinematics. Research questionTo assess the relationships between spino-pelvic/postural alignment parameters and gait kinematics in asymptomatic adults. Methods134 asymptomatic subjects (aged 18–59 years) underwent 3D gait analysis, from which kinematics of the pelvis and lower limbs were extracted in the 3 planes. Subjects then underwent full-body biplanar X-rays, from which skeletal 3D reconstructions and spino-pelvic and postural alignment parameters were obtained such as sagittal vertical axis (SVA), center of auditory meatus to hip axis plumbline (CAM-HA), thoracic kyphosis (TK) and radiologic pelvic tilt (rPT). In order to assess the influence of spino-pelvic and postural alignment parameters on gait kinematics a univariate followed by a multivariate analysis were performed. ResultsSVA was related to knee flexion during loading response (β = 0.268); CAM-HA to ROM pelvic obliquity (β = −0.19); rPT to mean pelvic tilt (β = −0.185) and ROM pelvic obliquity (β = −0.297); TK to ROM hip flexion/extension in stance (β = −0.17), mean foot progression in stance (β = −0.329), walking speed (β = −0.19), foot off (β = 0.223) and step length (β = −0.181). SignificanceThis study showed that increasing SVA, CAM-HA, TK and rPT, which is known to occur in adults with spinal deformities, could alter gait kinematics. Increases in these parameters, even in asymptomatic subjects, were related to a retroverted pelvis during gait, a reduced pelvic obliquity and hip flexion/extension mobility, an increased knee flexion during loading response as well as an increase in external foot progression angle. This was associated with a decrease in the walking pace: reduced speed, step length and longer stance phase.