Gait changes as the result of deformity reconstruction surgery in a group of adults with lumbar scoliosis.
METHODS
This was a prospective analysis of adult spinal deformity patients having fusions from the thoracic spine down to L5 or the sacrum. Gait analysis was performed before surgery and 1 and 2 years postoperatively, as was questionnaire analysis.


OBJECTIVE
To compare the preoperative and postoperative gait of revision and primary patients having long fusions to the distal lumbar spine or sacrum with that of a group of able-bodied adults. The experimental hypothesis was that both patient groups would have significantly compromised preoperative gait and gait endurance compared to the able-bodied group and that significant changes would be noted in both groups at 1 and 2 years postoperation.


BACKGROUND
Spinal reconstructive surgery is often performed on adults with progressive lumbar spinal deformities. These patients can be divided into two major groups. The first are those patients who have degenerative changes superimposed on idiopathic scoliosis (primary patients) without previous operative treatment; the second are those patients who have already had a long fusion to L4, L5, or the sacrum (revision patients).


METHODS
Twenty-nine women participated in the investigation (8 primary, 12 revision, 9 able-bodied controls). A gait analysis was performed before surgery and 1 and 2 years postoperation. Walking endurance (time) was estimated from a submaximal graded treadmill exercise test. Motion variables describing the gait of the subjects, as well as gait speed, were determined. The SRS, Oswestry questionnaires, and an analog pain scale were also administered.


RESULTS
The primary group showed no adverse changes in lower extremity kinematics after surgery, and their gait speed improved such that it was not significantly different from the able-bodied group at 2 years postoperation. The revision group displayed lower extremity gait kinematics that were significantly different from the able-bodied group before surgery, but were no longer different from the able-bodied 2 years after surgery. They also had a significant increase in gait endurance. Questionnaire data indicated significant improvements for both groups after surgery.


CONCLUSIONS
Objective gait data quantifying the efficacy of reconstructive spinal surgery in both primary and revision patients indicated improved gait. Gait endurance was improved in the revision group, and gait speed for the primary was not significantly different from able-bodied at 2 years postoperation. Clinically, it would appear that rehabilitation strategies to improve gait endurance and gait speed could be implemented to further improve the gait of these patients.
Engsberg
Jack R
JR
Human Performance Laboratory, Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
Bridwell
Keith H
KH
Wagner
Joanne M
JM
Uhrich
Mary L
ML
Blanke
Kathy
K
Lenke
Lawrence G
LG
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D003627:Data Interpretation, Statistical; D005684:Gait; D006615:Hip / Q000503:physiopathology; D006801:Humans; D007717:Knee / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000503:physiopathology* / Q000601:surgery; D008875:Middle Aged; D016059:Range of Motion, Articular; D012600:Scoliosis / Q000503:physiopathology* / Q000601:surgery; D012782:Shoulder / Q000503:physiopathology; D016138:Walking