Impact of Fatigue on Maintenance of Upright Posture: Dynamic Assessment of Sagittal Spinal Deformity Parameters After Walking 10 Minutes.
METHODS
Retrospective analysis of prospectively collected data.


OBJECTIVE
To assess global and regional spinal sagittal radiographic parameters in adults with loss of lumbar lordosis ("flatback") before and after walking 10 minutes.


BACKGROUND
While routine activities of daily living may exacerbate functional disability of spinal sagittal-plane deformity, there is limited understanding of how sagittal parameters and compensatory mechanisms are affected by activity.


METHODS
Consecutive adults with "flatback" at a single institution who previously had full-length standing spinal radiographs before and after walking 10 minutes were reviewed. Changes in spinal deformity sagittal parameters before and after walking were evaluated for two groups: Compensated Sagittal Deformity ("Compensated": sagittal vertical axis [SVA] ≤4 cm and pelvic tilt [PT] >20°) and Decompensated Sagittal Deformity ("Decompensated": SVA>4 cm and PT>20°). Intra-group radiographic comparisons were performed with paired Student t tests.


RESULTS
One hundred fifty-seven patients (143 females, 14 males; average age 67.9 ± 5.9 yr) met inclusion criteria. Initial average SVA was 1.7 ± 1.2 cm for "Compensated" and 11.5 ± 6.4 cm for "Decompensated." After walking 10 minutes, significant deteriorations in average SVA were observed for all "Decompensated" patients and 84.6% of "Compensated" patients. For both groups, this was accompanied by significant decreases in PT and LL and increases in PI-LL (P <0.01). Thoracic kyphosis increased after walking for only "Decompensated" (P <0.01). For "Compensated," the change in SVA was determined by decreases in PT and LL, while changes in SVA for "Decompensated" were correlated to worsening of all sagittal parameters.


CONCLUSIONS
After walking, compensatory mechanisms to maintain sagittal balance in adults with spinal deformity are less pronounced than when the patient initially presents. This results in significant sagittal decompensation, irrespective of the initial SVA. As we postulate that loss of compensatory mechanisms is due to fatigue on pelvic and spinal extensor muscles, sagittal parameters can be re-evaluated with radiographs obtained after patients walk 10 minutes to unmask a hidden sagittal imbalance in compensated deformities.


METHODS
3.
Department of Neurological Surgery, Spine Health Wooridul Hospital, Seoul, South Korea.
Junseok
J
Bae
Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA.
Alexander A
AA
Theologis
Department of Neurological Surgery, Suwon Nanoori Hospital, Suwon, South Korea.
Jee-Soo
JS
Jang
Department of Neurological Surgery, Spine Health Wooridul Hospital, Seoul, South Korea.
Sang-Ho
SH
Lee
Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA.
Vedat
V
Deviren
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000150:complications / Q000000981:diagnostic imaging*; D008141:Lordosis / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011187:Posture / Q000502:physiology*; D012189:Retrospective Studies; D013997:Time Factors; D016138:Walking / Q000502:physiology*