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Although the twenty-first century has seen major advances in evidence-based medicine to improve health, athletic performance, and injury prevention, our inability to implement these best practices across underserved American communities has limited the impact of these breakthroughs in sports medicine. Rochester, NY is stereotypical of American communities in which an economically challenged racially diverse urban center with grossly underperforming public schools is surrounded by adequately resourced predominantly Caucasian state-of-the-art education systems. As these great disparities perpetuate and further degrade our society in the absence of interventions, the need for community engagement initiatives is self-evident. [ABSTRACT FROM AUTHOR]

Healthcare reforms that demand quantitative outcomes and technical innovations have emphasized the use of Disability and Functional Outcome Measurements (DFOMs) to spinal conditions and interventions. Virtual healthcare has become increasingly important following the COVID-19 pandemic and wearable medical devices have proven to be a useful adjunct. Thus, given the advancement of wearable technology, broad adoption of commercial devices (ie, smartwatches, phone applications, and wearable monitors) by the general public, and the growing demand from consumers to take control of their health, the medical industry is now primed to formally incorporate evidence-based wearable device-mediated telehealth into standards of care. To (1) identify all wearable devices in the peer-reviewed literature that were used to assess DFOMs in Spine, (2) analyze clinical studies implementing such devices in spine care, and (3) provide clinical commentary on how such devices might be integrated into standards of care. A systematic review. A comprehensive systematic review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA) across the following databases: PubMed; MEDLINE; EMBASE (Elsevier); and Scopus. Articles related to wearables systems in spine healthcare were selected. Extracted data was collected as per a predetermined checklist including wearable device type, study design, and clinical indices studied. Of the 2,646 publications that were initially screened, 55 were extensively analyzed and selected for retrieval. Ultimately 39 publications were identified as being suitable for inclusion based on the relevance of their content to the core objectives of this systematic review. The most relevant studies were included, with a focus on wearables technologies that can be used in patients' home environments. Wearable technologies mentioned in this paper have the potential to revolutionize spine healthcare through their ability to collect data continuously and in any environment. In this paper, the vast majority of wearable spine devices rely exclusively on accelerometers. Thus, these metrics provide information about general health rather than specific impairments caused by spinal conditions. As wearable technology becomes more prevalent in orthopedics, healthcare costs may be reduced and patient outcomes will improve. A combination of DFOMs gathered using a wearable device in conjunction with patient-reported outcomes and radiographic measurements will provide a comprehensive evaluation of a spine patient's health and assist the physician with patient-specific treatment decision-making. Establishing these ubiquitous diagnostic capabilities will allow improvement in patient monitoring and help us learn about postoperative recovery and the impact of our interventions. [ABSTRACT FROM AUTHOR]

Background: Changes in balance are common in individuals with spinal disorders and may cause falls. Balance efficiency, is the ability of a person to maintain their center of gravity with minimal neuromuscular energy expenditure, oftentimes referred to as Cone of Economy (CoE). CoE balance is defined by two sets of measures taken from the center of mass (CoM) and head: 1) the range-of-sway (RoS) in the coronal and sagittal planes, and 2) the overall sway distance. This allows spine caregivers to assess the severity of a patient's balance, balance pattern, and dynamic posture and record the changes following surgical intervention. Maintenance of balance requires coordination between the central nervous and musculoskeletal systems.Research Question: To discern differences in balance effort values between common degenerative spinal pathologies and a healthy control group.Methods: Three-hundred and forty patients with degenerative spinal pathologies: cervical spondylotic myelopathy (CSM), adult degenerative scoliosis (ADS), sacroiliac dysfunction (SIJD), degenerative lumbar spondylolisthesis (DLS), single-level lumbar degeneration (LD), and failed back syndrome (FBS), and 40 healthy controls were recruited. A functional balance test was performed approximately one week before surgery recorded by 3D video motion capture.Results: Balance effort and compensatory mechanisms were found to be significantly greater in degenerative spinal pathologies patients compared to controls. Head and Center of Mass (CoM) overall sway ranged from 65.22 to 92.78 cm (p < 0.004) and 35.77-53.31 cm (p < 0.001), respectively in degenerative spinal pathologies patients and in comparison to controls (Head: 44.52 cm, CoM: 22.24 cm). Patients with degenerative spinal pathologies presented with greater trunk (1.61-2.98°, p < 0.038), hip (4.25-5.87°, p < 0.049), and knee (4.55-6.09°, p < 0.036) excursion when compared to controls (trunk: 0.95°, hip: 2.97°, and knee: 2.43°).Significance: The results of this study indicate that patients from a wide variety of degenerative spinal pathologies similarly exhibit markedly diminished balance (and compensatory mechanisms) as indicated by increased sway on a Romberg test and a larger Cone of Economy (CoE) as compared to healthy controls. Balance effort, as measured by overall sway, was found to be approximately double in patients with degenerative spinal pathologies compared to healthy matched controls. Clinicians can compare CoE parameters among symptomatic patients from the different cohorts using the Haddas' CoE classification system to guide their postoperative prognosis. [ABSTRACT FROM AUTHOR]

The aim of this manuscript is to describe knowledge gaps in the literature, future directions, and emerging applications of gait and balance analysis in spine surgery with regard to functional outcomes measurement. Functional outcome measurement has been established as a useful clinical and research investigational tool in musculoskeletal disease. Evidence currently supports its use in the diagnosis, treatment, and outcome measurement of multiple musculoskeletal disease states, including spinal disease, and its usefulness continues to grow as literature develops. Gait and balance analysis has proven to be broadly applicable, but most clinicians remain unfamiliar and untrained in its usage. The logistical and communication barriers are also described with the potential solutions that are on the near horizon of research. This article describes our methodology for improving conveyance of functional outcome measures in spine surgery. Additionally, we provide a case example of an adult patient with spinal deformity who is examined pre and post operatively using our methodology. [ABSTRACT FROM AUTHOR]

Background Context: Gait impairment is a hallmark of cervical spondylotic myelopathy (CSM). It has been shown to affect quality of life but has not been well defined. Further electromyographic (EMG) characterization of the gait cycle may help elucidate the true neuromuscular pathology with implications on prognosis and rehabilitation techniques.Purpose: This study compares neuromuscular activity in patients with CSM to that of healthy age-matched controls.Study Design: Nonrandomized, prospective, concurrent control cohort study.Methods: Neuromuscular activity was measured in 40 patients with symptomatic CSM during a series of over-ground gait trials at a self-selected speed before surgical intervention. External oblique, multifidus, erector spinae, rectus femoris, semitendinosus, tibialis anterior, medial gastrocnemius, and medial deltoid were assessed. Identical measurements were taken in 25 healthy control patients. Differences in time of muscle onset, peak EMG, time to peak EMG, and integrated electromyography (iEMG) were assessed using one-way ANOVA.Results: There were no significant differences between patients with CSM and healthy controls with respect to time of muscle contraction onset. Peak EMG muscle activity was significantly higher in the medial deltoid of patients with CSM (39.3% vs. 23.3% sMVC, p=.042), but no other differences were seen in the remaining muscles tested. They also demonstrated significantly longer time to peak EMG muscle activity compared with controls in 5 of the 8 muscles tested, including the multifidus (20.2 vs. 16.8 ms, p=.050), erector spinae (18.2 vs. 8.9 ms, p<.001), semitendinosis (26.3 vs. 22.4 ms, p=.037), tibialis anterior (14.7 vs. 11.0 ms, p=.050), and medial deltoid (24.2 vs. 9.2 ms, p<.001). Compared with controls, patients with CSM demonstrated significantly higher iEMG activity in the semitendinosis (586.5% vs. 272.5 sMVC, p=.047) and medial deltoid (87.62% vs. 22.5% sMVC, p=.008).Conclusions: The onset of muscle activity is not delayed in CSM patients, but many key muscles take longer to fully contract. This produces a situation in which patients with CSM are unable to fully fire their muscles with sufficient speed to maintain a normal gait. The core and lower extremity muscles do not contract with increased peak amplitude in response, but the deltoid and hamstring muscles are more active, suggesting compensatory activity as patients attempt to maintain balance. The end result is less efficient ambulation. These findings provide a more nuanced understanding of gait in individuals suffering from CSM and may have implications on rehabilitation protocols. [ABSTRACT FROM AUTHOR]

Background Context: Cervical spondylotic myelopathy (CSM) typically manifests with a slow, progressive stepwise decline in neurologic function, including hand clumsiness and balance difficulties. Gait disturbances are frequently seen in patients with CSM, with more advanced cases exhibiting a stiff, spastic gait.Purpose: To evaluate the spatiotemporal parameters and spine and lower extremity kinematics during the gait cycle of adult patients with CSM before surgical intervention.Study Design: Prospective cohort study.Patient Sample: Twenty-eight subjects with symptomatic CSM who have been scheduled for surgery and 30 healthy controls (HC).Outcome Measures: Spine and lower extremity kinematics and spatiotemporal parameters.Methods: Clinical gait analysis was performed for patients with CSM and HC. The data were analyzed with a one-way analysis of variance.Results: Patients with CSM have significantly more anterior pelvis tilt (CSM: 13.97°, HC: 5.56°), larger lumbar lordosis (CSM: 8.59°, HC: 2.7°), smaller cervical lordosis (CSM: 6.02°, HC: 11.35°), and less head flexion (CSM: 0.69°, HC: 8.66°) at the beginning of the gait cycle. There was a decrease in knee range of motion in patients with CSM compared with controls (CSM: 36.31°, HC: 50.17°). Furthermore, patients with CSM presented with slower walking speed (CSM: 0.81 m/s, HC: 1.05 m/s), decreased cadence (CSM: 95.57 step/m, HC: 107.64 step/m), increased double support time (CSM: 0.40 s, HC: 0.28 s) and stride time (CSM:1.28 s, HC: 1.13 s), shorter stride length (CSM: 1.04 m, HC: 1.18 m) and step length (CSM:0.51 m, HC: 0.58 m), and wider width (CSM: 0.14 m, HC:0.11 m).Conclusions: Our study shows that patients with CSM enter the gait cycle with a larger anterior pelvic tilt and lumbar lordosis as well as less cervical lordosis and head flexion. As a consequence of these abnormal spinal parameters at the onset of the gait cycle, lower extremity biomechanics are also altered. Our study is the first to demonstrate the relationship between aberrant spinal alignment and lower extremity function. Identification of this interrelationship as well as the specific gait and biomechanical disturbances seen in myelopathic patients can both inform our understanding of the disease and tailor rehabilitation protocols. [ABSTRACT FROM AUTHOR]

Functional outcome measurements (FOMs) have been shown to be effective tools in diagnosing, planning treatments and tracking outcomes in several subspecialties of medicine. FOMs often produce large volumes of complex data that require sophisticated collection, storage and analytic techniques to describe functional measures of items like gait performance, postural stability, neuromuscular activity and movement strategies. These complexities pose particular challenges for the application of FOMs in the clinical setting where the primary focus is on patient care. Currently, utilization of FOMs is primarily driven by individual surgeons explicitly interested in the development and dissemination of FOMs metrics and related technologies. Unfortunately, there are capital and support costs associated with running and maintaining FOMs labs which pose additional hurdles that may inhibit otherwise interested surgeons. As interest and use of clinically derived functional evaluations tailored specifically for spine patients grow, there is a need for simple, objective measures to summarize the complexity of modern motion tracking data sets to simple, clinically meaningful and interpretable terms. To develop and validate low-cost FOMs wearable sensor that quantifies common activities in a home-based environment. Prospective, concurrent control cohort study. Twelve lumbar degenerative surgical candidates and 12 healthy controls participated in this study. Level of activity, spatiotemporal parameters, and balance effort. Subjects wore a small noninvasive sensor (30 × 44 × 8mm, weight: 12 grams) with an adhesive patch on T1 in addition to traditional gait lab sensors. Validation of the proposed sensor and common FOMs metrics generated by a gait lab were compared. Furthermore, each subject wore the wearable sensor on T1 for additional 24 hours. The sensor detected different types and levels of activities during the day (ie, standing, walking, sitting, etc.) and also captured trunk kinematics in the home-based environment. The wearable sensor was able to reliably measure all trunk kinematics during standing, walking and transition from sitting (p>0.05) when compared to gold standard human motion capture in a gait lab. The sensor data collected during the additional 24-hours at home was passed through a machine learning activity classification algorithm. The predicted results indicate that patients with degenerative lumbar spinal pathologies presented with a lower level of activity (walking: 4.7%, standing: 11.6%, sitting: 25.3%) in comparison to controls (walking: 7.9%, standing: 21.7%, sitting: 17.1%). Balance effort and the CoE dimensions were found to be significantly larger in these patients (sagittal: 7.9°, coronal: 7.2°) compared to controls (sagittal: 5.8°, coronal: 3.2°; p<0.035). The purpose of this study was to validate and prove the feasibility of home-based functional outcome measurements, which can provide relevant details in a digestible format that conveys the functional status of the patient and raises flags for areas of concern. Such insights may lead to changes in assessments of disability, treatment strategies or modifications of rehabilitation regimens. Several benefits are anticipated from a wearable-based quantitative tool to assist with preoperative planning for patient-specific alignment objectives such as assisting in choosing the right surgical procedure for the right patient, recognition of red flags, leading to avoidance of surgery where it is not going to help, recovery monitoring, early detection of perioperative complications, prognostic information, and prediction of treatment outcomes. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Dubousset first introduced the concept of the cone of economy (CoE) as a reference to the area of standing posture that illustrates energy expenditure. Two decades later, Haddas et al developed a method to quantify the CoE. This concept has been quickly adopted and has made a significant impact on our understanding of concepts such as sagittal balance and restoration of alignment to decrease the physiologic burden of gait and balance. As imbalance increases, the patient deviates from the center of the cone, resulting in a larger CoE. The resources currently required to evaluate the CoE are substantial as it requires a full array of motion capture sensors in a gait lab run with highly-trained staff. This is a significant hurdle to the widespread clinical use of CoE measurements. Haddas et al established a cheaper way, although still limited to a lab or clinical setting, to quantify the CoE using a force platform. Therefore, there is a need for elementary and objective measures to condense the complexity of modern motion tracking data sets to fundamental, clinically meaningful, and interpretable terms which can be used at the clinic or the patient's home. To compare CoE between spine patients and controls in their home-based environment. Prospective, concurrent control cohort study. Twelve lumbar degenerative surgical candidates (LD; Age: 59.6, Height: 1.68 m, Weight: 71.5 kg) and 12 healthy controls (C; Age: 46.1, Height: 1.74 m, Weight: 80.1 kg). Balance effort and CoE dimensions. Subjects wore a small sensor (30 x 44 x 8mm, weight: 12 grams) with a patch on T1 for 24 hours. The sensor detected trunk sway and range of motion (RoM) for different types of activities during the day and also captured the patient's level of activity in the patient's natural environment. Balance effort and CoE dimensions were found to be significantly greater in degenerative lumbar spinal pathologies patients compared to controls. Standing and walking Range of Sway (RoS) found to be significantly larger in both sagittal (Standing: LD: 7.9° vs C: 5.8°, p < 0.050) and coronal (Standing: LD: 7.2° vs C: 3.2°, p < 0.050; Walking: LD: 18.4° vs C: 13.1°, p < 0.001) planes in spine patients in comparison to controls. Moreover, patients with degenerative lumbar spinal pathologies presented with lower levels of activity (Walking:4.7%, Standing: 11.6%, Sitting: 25.3%) in comparison to controls (Walking:7.9%, Standing: 21.7%, Sitting: 17.1%). This study established the technical feasibility of providing spine caregivers with a practical method for producing home-based objective global balance data via CoE measurements from a wearable device. Several benefits are anticipated from this quantitative wearable tool to assist with preoperative planning for patient-specific alignment objectives and also prognostic information, recovery monitoring and treatment outcomes. Spine surgeons may consider incorporating this technology into their clinical practice as wearable devices are relatively affordable, portable and straightforward to use. Moreover, using this data with the Haddas' CoE classification system will help to identify patients that may benefit from surgery and guide their postoperative prognosis. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Cervical spondylotic myelopathy (CSM) tends to produce a progressive decline in function characterized by gait disturbance, worsening balance and loss of upper extremity dexterity. Traditionally, the goal of decompressive surgery for CSM was to arrest neurological deterioration and prevent further disability rather than to provide functional recovery. In recent years, studies utilizing functional outcome measurements (FOMs) have demonstrated objective improvements in gait and balance dysfunction out to three months after surgery for CSM, but 1-year follow-up has yet to be reported. To determine whether the trends in improvements in gait, balance, pain levels, and psychological profiles observed at three months after cervical decompression for CSM continue out to one year postoperatively. Prospective, concurrent control cohort study. The study included 22 symptomatic CSM patients, 20 age-matched healthy control volunteers (C). Gait and balance parameters, neck disability index (NDI), Visual analog scale (VAS) neck, and psychological measures – Tampa Scale for Kinesiophobia (TSK) and Fear Avoidance Beliefs Questionnaire (FABQ). Patients performed gait and balance evaluations prior to surgery (Pre) and at 3 months (Post3) and 12 months (Post12) postoperatively. Functional data were recorded and analyzed using human motion capture and dynamic surface EMG. Patients also completed outcomes questionaries at the same time points. Repeated measurements and one-way analysis of variance (ANOVA) were used to analyze data. Continued improvement in multiple gait parameters was observed out to one year postoperatively: faster walking speed (Post3: 0.92 vs Post12: 0.99 m/s, p=0.048; C: 1.02 m/s, p>0.050), shorter step time (Post3: 0.44 vs Post12: 0.42 s, p=0.041; C: 0.42 s, p>0.050), and longer step length (Post3: 0.52 vs Post12: 0.55, p=0.048; C: 0.57, p>0.050). Additional gains in balance occurred between 3 and 12 months: head total sway (Post3: 57.70 vs Post12: 51.35 cm, p=0.045 cm; C: 46.42, p>0.050) as well as cone of economy (CoE) dimensions in the coronal plane for both the head (Post3: 3.14 vs Post12: 2.55 cm, p=0.037 cm; C: 2.19, p>0.050) and center of mass (Post3: 2.11 vs Post12: 1.85 cm, p=0.034 cm; C: 1.64, p>0.050). There were significant improvements in all PROMs after surgery: VAS neck (Pre: 5.4, Post3, 2.1, Post12 1.3, p<0.021) and NDI (Pre: 44.6, Post3: 28.5, Post12 20.1, p=0.032). Progressive improvements were observed in TSK and FABQ scores (p<0.050). This study reports objective functional measures and psychological outcomes in addition to standard patient-reported outcome measures for CSM patients out to one year postoperatively, thereby providing a comprehensive global assessment of their recovery. Select measures of gait and balance improved at all time points postoperatively and ultimately resembled those of the healthy controls at one year. These results provide important insight regarding the continued recovery that occurs between 3 and 12 months after surgical decompression for CSM. In turn, this information enriches the discussion surgeons can have with patients before and after surgery. FOMs provide both clinicians and patients with a more detailed and sensitive assessment of overall treatment outcomes and the timeframe of functional recovery. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Non-operative treatment is regarded as the first-line of therapy for patients with adult spinal deformity (ASD) without neurologic deficits or significant impairment. While there is high-level evidence supporting the use of rigid bracing in adolescent idiopathic scoliosis, there is a paucity of literature pertaining to the use of scoliosis support orthosis (SSO) in ASD patients. To investigate the impact of an SSO on pain, gait parameters, and functional balance measures in symptomatic ASD patients. Prospective cohort study. Thirty ASD patients (26 Females, Age: 72.7, Cobb Angle: 47.1°) Six-minute walk test, Time Up and Go test, 3D Gait analysis, Cone of Economy analysis, VAS, ODI, SRS22r, Fear Avoidance Beliefs Questionnaire (FABQ) [32], and Tampa Scale for Kinesiophobia (TSK). Thirty ASD patients were evaluated on 3 different occasions: first day of bracing: baseline (Pre), and 45-min post fitting (Post45m), and after 8-weeks of bracing for 4 hours a day (Post8w). Each patient performed a 6-minute walk (over-ground gait), a dynamic balance test, and completed VAS, ODI, and SRS22r. Significant short- and long-term improvements using SSO were found in the 6-minute walk (Pre: 278.6; Post45m: 322.2; Post8w: 338.8 m, p<0.001), walking speed (Pre: 0.88; Post45m: 0.97; Post8w: 0.97 m/s, p<0.001), head total sway distance during the balance test (Pre: 81.33; Post45m: 68.63; Post8w: 60.72 cm, p=0.048), low-back pain (VAS: Pre: 5.5; Post45m: 3.5; Post8w: 3.3, p<0.001), and for the ODI (Pre: 41.9; Post45m: 32.9; Post8w: 30.1, p=0.005). This study demonstrated clinically significant improvements in PROMs, spatiotemporal gait parameters and functional balance measures with the use of a SSO for patients with ASD. Some improvements were established immediately following brace fitting and many improvements were observed after wearing SSO for 8 weeks. In addition, this is the first SSO study for ASD to examine gait parameters and functional balance measures in order to understand the benefits of non-operative treatment from a functional and activity of daily living perspective. Based on the results of this study, it is reasonable to consider custom fitted SSO as a treatment option to provide a measurable degree of pain relief and improvement of function for patients with ASD, if the goals of treatment match the measured benefits demonstrated in our paper. Future studies are warranted to investigate if the observed benefits can be maintained over longer periods, possibly with reduced wear times for patients with ASD. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Social media allows millions of users of different geographic, political, socioeconomic and national backgrounds to communicate and exchange information worldwide. The internet and social media use have sky-rocketed in the past 15 years. Seventy-two percent of all adults have used social media to gather health care information. The use of social media by providers can enhance patient education, complement offline information, allows patients to receive support, stimulate brand building and strengthen the organization's market position. The number of patients showing up to their doctor's office with a diagnosis in hand from the internet continues to grow compared to as little as 10-15 years ago. Social media can be utilized by the technologically-savvy spine surgeon to grow their exposure and brand. Risks of social media include, but are not limited to, a lack of quality, reliability, and credibility misrepresentation of credentials, influence of hidden and overt conflicts of interest, and content that may jeopardize patient privacy, HIPAA regulations, and physicians' credentials and licensure. As physicians' use of social media may expose him/her to lawsuits if providing specific medical advice on media platforms, informed consent should be obtained prior to online discussions regarding medical care between health care providers and patients. To highlight the benefits and risks of having and maintaining a social media presence. Cross-sectional observational. A total of 325 Spine Surgeons from 76 institutions across the US. Surgeons' age, gender, years of experience, clinic type and size, years at the current practice, and publication record, along with surgeon's social media involvement. We performed web-based searches of spine surgeons using the North American Spine Society Fellowship Database. We defined "active" presence as the frequency and type of social media posts relating to Spine Surgery. We described the sample using frequency for categorical variables and mean for continuous variables. Moreover, we used Pearson's correlation to investigate the relationships between the variables. Out of the 235 surgeons, 96% were males with an average age of 51.5±10.7 years and 14.1±9.6 years of experience. There were 41.4% of these practices that included at least 8 surgeons, and 25.2% and 19.0 for more than 20 surgeons and less than 2 surgeons, respectively. The frequency for social media included 17.8% of surgeons had professional Facebook, 13.8, 8.9, 6.8, 57.6, and 22.55% had Twitter, Instagram, YouTube, LinkedIn, and personal websites, respectively. When combining all platforms together, 64.6% of all surgeons had at least one professional social media platform. Also, 64.0% of these surgeons had no social media activity in the past 90 days, while 19.4 and 10.9% were active once and twice a month, respectively. Surgeon age (p=0.004), years in practice (p<0.001), and practice type (p<0.001) were positively correlated with social media activity. Professional social media activity level was not correlated with surgeon age nor experience but was correlated to their publication record (p=0.019), having a personal practice website (p<0.001), and the number of active social media (p<0.001). Given the scarcity of research on this topic and the novelty of the platforms, social media and online services continue to be underutilized by spine surgeons. Issues regarding the risks of privacy issues with social media users continue to be a concern amongst medical professionals adopting this technology. This can largely be mitigated with the combination of physician education and informed consent from patients. The ability to connect with patients directly and provide high-quality education and information will continue to benefit our field well into the future. With the rapidly evolving nature of social media platforms, surgeons who do not stay abreast will likely fall behind and lose influence over time. As leaders in our communities, spine surgeons should strive to stay involved and be constantly ready to adapt to the changing online landscape. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

While spine surgery can produce good outcomes in many patients, there are patients who do not benefit from the intervention and have conditions not thought not to be addressable by surgical intervention. These failed back surgery syndrome (FBSS) patients may be candidates for spinal cord stimulation (SCS) for pain management. While multiple studies have reported benefits of SCS related to pain reduction, improved quality of life, and reduced pain medication intake, there has been little investigation into measurable physical functional improvement in this population. The purpose of this study was to evaluate the effect of SCS on traditional self-reported pain and functional measures, the psychological parameter of kinesiphobia, as well as functional measures of balance and gait, in FBSS patients. Prospective repeated-measures design. A total of 15 symptomatic FBSS patients eligible for SCS. Outcome assessment was based on visual analog scales (VAS) for back and leg pain, Oswestry Disability index (ODI), Tampa Scale for Kinesiophobia (TSK) and functional testing components including balance, sway and gait. Patients completed patients reported outcomes and functional evaluations prior to the SCS trial procedure (Pre) and at 6 (Post6) and 12 (Post12) weeks after SCS implantation. Gait and balance were evaluated using 3D human motion capture and dynamic surface EMG. Balance effort and Cone of Economy (CoE) dimensions were as measured by total sway and range of sway (RoS), respectively. Repeated measurements and one-way analysis of variance (ANOVA) were used to analyze data. SCS implant significantly improved gait and balance in FBSS patients. The following gait parameters showerd significant improvement: Walking speed (Pre: 0.75, Post6: 0.86, Post12: 0.92 m/s, p<0.011), cadence (Pre: 85.42, Post6: 94.1, Post12: 95.94 steps/m, p<0.032), stride length (Pre: 0.98, Post6: 1.05, Post12: 1.07 m, p<0.049), and gait deviation index (GDI; Pre: 74.0, Post6: 83.2, Post12: 90.8, p<0.012). Additionally, significant improvements were seen in balance effort (head sway, Pre: 80.2, Post6: 52.2, Post12: 50.0 cm, p<0.049) sway dimensions as seen by reduced sagittal (p<0.047) and coronal (p<0.042) sway. For patient-reported outcomes, significant improvements were noted for VAS low back (Pre: 6.5, Post6: 3.6, Post12: 3.9, p<0.036), ODI (Pre: 57.6, Post6: 39.7, Post12: 38.3, p<0.006). Scores on the and TSK also improved significantly (p<0.044). The results of this study support prior literature reporting significant improvement in pain and self-reported function reflected in VAS and ODI scores. Additionally, significant improvements were found post-SCS in gait and balance. The results suggest that SCS is associated not only with significant improvement in patient self-reported outcome measures, but also with physical functional testing. The patients included in this study showed more efficient gait patterns and improves balanced. This may be reflective of an overall improvement in activities of daily living following SCS implantation. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

In the diagnosis and treatment of adult spinal deformities, static radiographic measurements in the sagittal and coronal anatomical planes and patient-reported outcome measures (PROMs) serve as the gold standard for assessment of spinal alignment and deformity. However, there is a lack of published literature on their relation to objective functional outcome measures (FOMs) among patients afflicted with adult spinal deformity. Adult spinal deformity (ASD) is due to degeneration, functional decline is partly due to loss of postural stability and neuromuscular capacity and coordination. Objective functional measures (eg, static standing and walking alignment) cover more information than just radiographic alignment in the ASD population. Gait and dynamic balance analysis can reveal functional compensatory alignment changes where static imaging is limited. Previous studies have shown improvement in postoperative gait, approximating non-ASD control cohorts but still symptomatic. Many studies have shown surgical reconstruction in ASD patients has improved patient outcomes, but not overall assessment of objective function along with psychological factors. Therefore, a more comprehensive standard outcome measurement is needed. To determine the one-year effects of spinal alignment on function in ASD patients following surgical treatment using radiographic parameters, 3D gait and balance analysis, PROMs, and psychological tests and compared to healthy control. Nonrandomized, prospective study. Forty-three symptomatic ASD patients, 24 age-matched control. Gait spatiotemporal parameters, dynamic balance as measurement by balance effort and Cone of Economy (CoE) dimensions, radiograph alignment measurements, PROMs, and psychological factors. Patients performed dynamic balance and gait evaluations prior to surgery (Pre), 3 months (Post3), and 12 months (Post12) postoperatively. Patients also completed full-length, head-to-toe, micro-dose X-rays along with PROMs, and psychological questionnaires. Balance effort and CoE dimensions were measured by total sway and range of sway, respectively. Repeated measurement analysis of variance (ANOVA) and one-way ANOVA were used to determine differences in radiographic, dynamic balance, gait, and PROMs parameters at Post3 and Post12 and to the match control group. Significant improvements in radiographic alignment were found in Cobb angle (<0.001), sagittal (<0.009) and coronal (<0.003) vertical axes and pelvic incidence-lumbar lordosis mismatch (<0.001) at Post3 and Post12. There were significant improvements in all PROMs after surgery (VAS mid-back, low back, and leg, ODI and SRS). Surgical intervention resulted in a significant decrease in balance effort (head: p<0.017 and center of mass: p<0.042) and reduced in the CoE dimensions (sagittal: p<0.004; and coronal: p=0.029). Gait was also enhanced after surgery as seen with a faster walking speed (p<0.024) and longer stride length (p<0.024). Psychological factors showed significant improvements in Tampa Scale for Kinesiophobia and Fear Avoidance Belief Questionnaire scores (p<0.050). This is the first study to provide insight into a comprehensive global assessment of ASD surgery patients' function which includes complete objective functional and psychological outcomes in addition to standard PROMs and radiographic alignment. Balance effort and CoE limits improved at all time points post-operatively and ultimately matched the controls at 12 months. Similar to the significant improvement in static and dynamic balance in these patient groups, gait parameters also improved Post3 and Post12 to closely resemble the control group and continued to improve over time. Our findings present a more comprehensive set of outcome metrics, which, once combined, provide a more detailed and sensitive assessment of overall treatment outcomes. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Cervical spondylotic myelopathy (CSM) is a neurologic condition resulting from spinal cord compression due to degenerative narrowing of the spinal canal. It is the most common cause of spinal cord dysfunction in patients older than 50. Symptoms of CSM may include numbness or weakness in the extremities, loss of fine motor dexterity, and difficulty with balance and gait. The natural history is typically one of progressive decline in neurologic function, so surgery to decompress the spinal cord is generally indicated to prevent progression in symptomatic patients. Despite the prevalence of this condition, relatively little quantitative kinematic information is available on the effect of surgical intervention on the gait of patients with CSM. To evaluate for changes in the spine and lower extremity range of motion (RoM) during gait in patients with CSM before and after surgical intervention. Non-randomized, prospective, concurrent cohort study. Thirty-eight patients with symptomatic CSM. Lower extremity and spine range of motion (RoM), spatiotemporal parameters, and pain level. Clinical gait analysis was performed one week before surgery (Pre) and three months after surgery (Post). Fifty reflective markers (9.5 mm diameter) attached to the patients; bodies were utilized to collect full body three-dimensional kinematics using 10 cameras (VICON) at a sampling rate of 100 Hz. Each patient performed a series of over-ground gait trials at a comfortable, self-selected speed. Neck and mid-back visual analog scale (VAS), Oswestry Disability Index (ODI), and Neck Disability Index (NDI) scores were also collected at both time points. Repeated measurements ANOVA was used to analyze data. When comparing preoperative to postoperative gait parameters, significant increases in walking cadence (98.28 vs 103.37 steps/minutes, p=0.004), stride length (1.02 vs 1.07 m, p=0.018), and walking speed (0.86 vs 0.94 m/s, p=0.001) were observed. The amount of time spent in double support decreased after surgery (0.37 vs 0.32 s, p=0.032). The only significant difference in spine and lower extremity joint RoM measures was a decline in coronal RoM of both the knees and ankles postoperatively. VAS neck and mid-back as well as ODI improved significantly postoperatively, while the reduction in NDI did not attain statistical significance. Despite conventional teaching that the goal of surgical intervention for CSM is to halt symptomatic progression, the data presented here demonstrate that significant improvements in gait are frequently observed after surgical management of CSM. Postoperative patients walk more quickly as a result of increased stride length and cadence. Furthermore, they lift their knees and dorsiflex/plantarflex their ankles less, consistent with a more efficient gait pattern. While surgeons should remain conservative with respect to how they counsel patients and set expectations preoperatively, cautious optimism regarding improvements in gait may be warranted in the setting of surgery for CSM. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

BACKGROUND CONTEXT Recurrent low back pain (rLBP) commonly affects the recreational and professional athlete alike, and correlation between rLBP and lower extremity injury has been well established. Previous data have shown strong correlation between a history of back pain and altered landing mechanics, trunk and lower extremity kinematics and kinetic factors all associated with increased lower extremity injury. Additionally, there has been direct proven correlation between neuromuscular core training programs and a decrease in lower extremity ligamentous injuries. Fatigue has also been proven to negatively affect trunk and lower extremity neuromuscular control, which may predispose to lower extremity injury. Well reported gender differences in lower extremity kinetics and kinematics are also known to alter propensity for injury. The complex interplay between these various factors is continuously being studied. Proper understanding of these risk factors for spine and leg injuries is imperative in establishing proper neuromuscular control rehabilitation and training programs to mitigate the risks of lower extremity injury, especially in patients with a history of low back pain. PURPOSE To determine the effects of fatigue and gender on trunk and knee mechanics, neuromuscular control, and ground reaction force (GRF) during drop vertical jump (DVJ) following by unanticipated landing or cutting in a population with rLBP. STUDY DESIGN/SETTING A prospective concurrent control cohort study. PATIENT SAMPLE Thirty-two adults with rLBP. OUTCOME MEASURES 3D knee and trunk motion, knee moments, and GRF. METHODS All test patients were fitted with a full body marker set. Surface EMG electrodes were placed bilaterally on trunk and lower extremity muscles. Each patient performed multiple 0.30 m DVJ landing and cutting in nonfatigued and fatigued conditions. RESULTS Fatigue altered landing mechanics with differences in landing performance between genders. For DVJ trials, females had greater knee internal rotation at initial contact (p=.001). Maximum knee flexion was reduced, but knee adduction (p=.026) and internal rotation (p=.009) and trunk flexion (p=.003) were greater at maximum knee flexion. Similar differences were also found during the cutting trials, with the addition of less trunk side flexion (p=.008) in females at maximum knee flexion. Females had smaller knee flexion moments (p=.021) during the DVJ. Fatigue resulted in less trunk flexion (p=.027) at initial contact for the DVJ, and greater trunk extension (p=.038) and trunk side flexion (p=.035) at maximum knee flexion, smaller maximum vertical GRF on the right leg, and maximum knee adduction moment when cutting. CONCLUSIONS Females with rLBP land differently than males and may have increased exposure to biomechanical factors that can contribute to lower extremity injury. Fatigue similarly alters landing and increases exposure to those same factors in this population. The majority of gender and fatigue related differences were consistent for unanticipated landing and cutting activities, which may better simulate actual sports activity. Armed with additional information of movement behaviors associated with increased lower extremity injuries, practitioners can design neuromuscular control training programs for women with rLBP and for men and women during fatigued conditions that serve a protective function and decrease the potential of ACL and other lower extremity injuries. [ABSTRACT FROM AUTHOR]

BACKGROUND CONTEXT Balance is defined as the ability of the human body to maintain its center of mass (COM) within the base of support with minimal postural sway. Sway is the movement of the COM in the horizontal plane when a person is standing in a static position. Cervical spondylotic myelopathy (CSM) patients have impaired body balance and proprioceptive loss. PURPOSE To quantify the amount of sway associated with maintaining a balanced posture within the cone of economy (COE) in a group of untreated CSM patients and compare them to matched healthy controls. STUDY DESIGN/SETTING A prospective cohort study. PATIENT SAMPLE Thirty-two CSM patients and sixteen healthy controls (HC). OUTCOME MEASURES Center of mass (COM) and head sway, spine and lower extremityIntegrated Electromyography (iEMG). METHODS Thirty-two CSM patients performed a series of functional balance tests a week before surgery. Sixteen healthy controls (HC) performed a similar balance test. The functional balance test was essentially a Romberg's test in which the patients are required to stand erect with feet together and eyes opened in their self-perceived balanced and natural position for a full minute. All test subjects were fitted to a full body reflective markers set and surface EMG. RESULTS CSM patients presented more center of mass (COM) sway in the anterior-posterior (CSM: 2.87 vs. C: 0.74cm; p=.023) and right-left (CSM: 5.16 vs. C: 2.51cm; p=.003) directions and head sway (anterior-posterior – CSM: 2.17 vs. C: 0.82cm; p=.010 and right-left – CSM: 3.66 vs. C: 1.69cm; p=.044) and more COM (CSM: 44.72cm vs. HC: 19.26cm, p=.001) and head (Pre: 37.87cm vs. C: 19.93cm, p=.001) total sway in comparison to the healthy controls. CSM patients expended statistically significantly more muscle activity to maintain static standing, as manifest by increased muscle activity in their Multifidus (CSM: 22.25mV vs. HC: 12.39mV, p=.038), Erector Spinae (CSM: 26.76mV vs. HC: 14.41mV, p=.044), Rectus Femoris (CSM: 29.05mV vs. HC: 16.07mV, p=.037), and Tibialis Anterior(CSM: 23.06mV vs. HC: 14.48mV, p=.048) muscles during one minute standing in comparison to healthy control. CONCLUSIONS In symptomatic CSM patients, COM and head total sway were significantly greater than controls. Individuals with CSM exhibit more trunk and lower extremity muscle activity, and thus expend more energy to maintain a balanced, static standing posture. While most of the balance research in patients with spinal disorders is done based on static x-rays and mostly focused on sagittal spinal alignment, this study is the first effort to evaluate global balance as a dynamic process. [ABSTRACT FROM AUTHOR]

BACKGROUND CONTEXT Gait and balance analyses can provide an objective measure of function. Patients with adult degenerative scoliosis (ADS) demonstrate an altered gait and balance patterns. Spinopelvic parameters are commonly used by clinicians to evaluate patients with ADS. However, few studies have examined the correlation between patients' spinopelvic parametersoutcome and objective biomechanical gait and balance analyses. PURPOSE To determine the correlation between spinopelvic parameters with objective biomechanical measures of function. STUDY DESIGN/SETTING A prospective cohort study. PATIENT SAMPLE Thirty-nine patients with symptomatic ADS who have been deemed appropriate surgical candidates. OUTCOME MEASURES CVA, SVA, Cobb angle, PI-LL and T1PAalong with gait spatiotemporal parameters and COM and head sway during functional balance test. METHODS Gait and functional balance analyses were performed the week before surgery. Spatiotemporal parameters (ie gait speed, cadence, stride length, width and time etc.) were calculated during the gait evaluation. The functional balance test was similar to a Romberg's test. COM and head displacements in the sagittal and coronal planes and total sway amount along with spine and lower extremity neuromuscular activity were calculated. Furthermore, spinopelvic parameters were obtained on the same day of testing. Correlations were determined between the spinopelvic parameters and objective gait and balance analyses biomechanical data using Pearson's Product Correlation in SPSS. RESULTS The CVA was correlated with walking speed (r=0.343, p=.050), single support time (r=0.336, p=.050) during gait and external oblique (r=0.551, p=.008) muscle activity during the balance test. The SVA was correlated with horizontal COM (r=0.55, p=.004) and head (r=0.716, p=.001) sway in the coronal plane and gluteus maximus (r=0.450, p=.031) muscle activity during the balance test. The Cobb angle was correlated with COM total sway (r=-0.381, p=.050) and multifidus (r=−0.432, p=.035) muscle activity during the balance test. The PI-LL was correlated with single support time (r=0.493, p=.004) during gait and multifidus (r=0.406, p=.050) and semitendinosus (r=0.472, p=.023) muscle activity during the balance test. The T1PA was correlated with head sway in the coronal plane (r=0.403, p=.046) and external oblique (r=−0.484, p=.022) and gluteus maximus (r=0.387, p=.050) muscle activity during the balance test. CONCLUSIONS This study demonstrated a strong correlation between biomechanical parameters as measured with objective gait and balance analyses and spinopelvic parametersas measured with CVA, SVA, Cobb angle, PI-LL and T1PA. With higher values of the spinopelvic parameters, single support time, COM and head sway and neuromuscular activity were increased. Quantified gait and balance analyses can be a useful tool to evaluate patient outcomes. Objective functional performance measures can help to improve the evaluation and understanding of the biomechanical effects of spinal disorders on locomotion. [ABSTRACT FROM AUTHOR]

The term Cone of Economy (CoE) is commonly used when assessing balance in deformity patients. Recently a method that quantifies the CoE for a specific patient using 3D video kinematic and electromyography (EMG) data was developed. The present study further develops the method by evaluating what occurs inside the CoE using an analysis of balance control strategies. The postural control system uses distinct strategies such as the ankle, hip and suspensory strategies. Ankle strategy involves postural sway control from the ankles and feet. Hip strategy involves postural sway control from the pelvis and trunk. The suspensory strategy involves an adjustment of the center of mass (CoM) toward the base of support by bilateral lower-extremity flexion or a slight squatting motion. This study provides a method to quantify the CoE, neuromuscular energy expenditure, and balance control strategies associated with maintaining a balanced posture, in a group of adult degenerative scoliosis (ADS) patients. Nonrandomized, prospective, concurrent cohort study. Fifteen ADS patients and 15 nonscoliotic volunteers. Dimensions of CoE, overall sway inside the CoE, spine and lower extremity angles and neuromuscular activity at the minimum and maximum point of sway (sagittal and coronal). All patients were fitted with 51 external reflective markers. Surface EMG electrodes were placed on spine and lower extremity muscles. Patients performed a functional balance test that was similar to a Romberg's test, in which the patients were required to stand erect with their feet together and eyes open in their self-perceived balanced and natural position for a full minute. Data analyzed with repeated measurement ANOVA. ADS patients presented larger CoE dimensions (Head - Sagittal: ADS: 3.36 vs H: 1.39 cm; p=0.021; Coronal: ADS: 6.18 vs H: 3.31 cm; p=0.039; CoM - Sagittal: ADS: 2.16 vs H: 0.68 cm; p=0.023; Coronal: ADS: 3.46 vs H: 2.18 cm; p=0.010) along with more head (ADS: 56.19 vs 36.10 cm; p=0.003) and CoM (ADS: 36.37 vs 19.19 cm; p=0.002) overall sway inside the CoE in comparison to the nonscoliotic controls. At the peak sagittal sway for the head and CoM, ADS patients presented with more trunk and head flexion (p<0.005). At the peak coronal sway for the head and CoM, ADS patients presented with more knee and hip flexion (p<0.005). Scoliosis patients expended more muscle activity to maintain static standing, as manifest by increased muscle activity in their erector spinae (ADS: 39.21 mV vs H: 18.31 mV; p=0.010), and gluteus maximus (ADS: 31.89 mV vs H: 15.09 mV; p=0.029) muscles in comparison to the nonscoliotic controls. At the peak sagittal sway for the head and CoM, ADS patients presented with more erector spinae and gluteus maximus but less external oblique and tibialis anterior muscles activity (p<0.005). At the peak coronal sway for the head and CoM, ADS patients presented with more erector spinae and gluteus (p<0.005). ADS patients have larger CoE dimensions, increased sway and neuromuscular activity while using more hip and suspensory strategies in comparison to the nonscoliotic controls in their effort to maintain balance. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Accurate assessment of pain and function are crucial to the effective management of patients with spinal disorders. The most frequently-utilized measure of function is the Oswestry Disability Index (ODI), a self-report measure designed for low back pain patients, which assesses potential deficiencies in 10 different domains. The ODI has several limitations. Due to its subjective nature, ODI is inherently limited by factors such as recall error, social desirability, misinterpretation of terminology, and failure to quantify the totality of physical activity dimensions and contexts. Thus, the relationship between patients' self-reported ODI scores and their actual functional limitations is likely quite suspect. Gait analysis is an alternative objective tool that can both provide a clearer picture of the impact of pain on patients' functional ability and can allow for more accurate assessment of the effectiveness of spinal interventions. To investigate the relationship of self-reported function to objectively-measured gait pattern alterations in patients with spinal disorder. A prospective cohort study. A total of 235 spinal disorder patients (85 adult degenerative scoliosis, 66 cervical spondylotic myelopathy, 64 spondylolisthesis, and 20 sacroiliac). The main measures were ODI scores along with gait spatiotemporal parameters: cadence, walking speed, stride time, step time, opposite foot off, opposite foot contact, foot off, single support, double support, stride length, step length, and gait width. Patients completed the ODI questionnaire one week before their surgery. Each patient also performed a series of over-ground gait trials at a self-selected comfortable speed. Correlation analysis was used to determine the relationship between the self-reported function measures and the objective gait biomechanical data. The ODI overall score was not correlated with any of the spatiotemporal variables (p>0.050). Detailed analysis shows correlation between the ODI walking question score to stride length (r=-0.132, p=0.048) and gait width (r=0.133, p=0.046). For patients with spinal disorders, the ODI may not adequately reflect functional deficits due to its subjectivity. Function is objective and quantifiable, whereas pain in and of itself is subjective and unquantifiable. There was a minimal correlation between the ODI walking domain score and objective gait parameters. The multidimensional, complex, and subjective nature of pain makes it very challenging to assess both in terms of intensity and in terms of relief as a response to treatment. It is important for pain and function assessments to have scientifically valid tools in order to determine quality and intensity of pain and function, aid diagnosis, direct treatment, and evaluate effectiveness after discrete interventions. The data presented from this preoperative patient population validates that gait parameters provide an objectively accurate analysis of gait. Objective gait analysis could significantly affect surgical decision-making and allow for better understanding of the effects of spinal surgery on patients' function, and, ultimately, quality of life. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Difficulties with balance and gait are common manifestations of cervical spondylotic myelopathy (CSM). These patients present with altered balance and more trunk and lower extremity muscle activity when compared to healthy controls. To quantify the extent of change in balance and posture using dynamic testing in a group of CSM patients before and after cervical decompression surgery. Non-randomized, prospective, concurrent cohort study. Twenty-six CSM patients. Romberg's test: sagittal and coronal sway, total sway, and spine and lower extremity iEMG. Tandem gait test: gait speed, step length, step width, and trunk and head flexion angle. All test subjects were fitted with 51 external reflective markers. Surface EMG electrodes were placed on spine and lower extremity muscles. Spine and lower extremity integrated electromyography (iEMG) measurements were obtained. iEMG activity is a graphic representation of the sum total EMG activity over a defined period of time. Similar to a Romberg's test, patients were required to stand erect with their feet together and eyes open in self-perceived balanced and natural position for a full minute. Then, 10 steps of tandem gait were recorded. Data were analyzed with repeated measurement ANOVA. Surgical decompression reduced COM (Pre: 43.42 vs Post: 30.13 cm, p=0.033) and head (Pre: 59.90 vs Post: 41.36 cm, p=0.020) total sway and decreased muscle activity in their Erector Spinae (Pre: 23.59 vs Post: 14.40 mV, p=0.046), Gluteus Maximus (Pre: 17.48 vs Post: 10.37 mV, p=0.044), and Tibialis Anterior (Pre: 24.64 vs Post: 14.49 mV, p=0.037) muscles in CSM patients during the Romberg's test. Furthermore, surgical decompression increased gait speed (Pre: 0.25 vs Post: 0.41 m/s, p=0.013), reduced step length (Pre: 0.38 vs Post: 0.29 m, p=0.042) along with reduction in trunk (Pre: 32.45 vs Post: 19.15°, p=0.021) and head flexion (Pre: 50.11 vs Post: 32.54°, p=0.019) angle during the tandem gait test. Cervical decompression surgery improved dynamic balance in CSM patients. Three months after surgical intervention, CSM patients reduced their total sway. There was less muscle activity during a simple standing task and a reduction in spine and lower extremity energy expenditure. Surgical decompression improved patients balance capability and improved function in the tandem gait test. While most of the balance research in patients with spinal disorders is done based on static imaging and mostly focused on sagittal spinal alignment, this study is the first effort to evaluate global balance as a dynamic test. Quantifying and analyzing the specific balance alterations of patients with CSM not only provides a richer biomechanical understanding of normal and pathological balance, but also provides specific parameters that can be used in evaluating the severity of balance disturbance and postoperative recovery and rehabilitation. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

BACKGROUND CONTEXT Gait impairment is a hallmark of cervical spondylotic myelopathy (CSM) and has been shown to affect quality of life. Some studies describe the gait as spastic, while others suggest a paretic component. Further electromyographic (EMG) characterization of the gait cycle may help elucidate the true neuromuscular pathology with implications on prognosis and rehabilitation techniques. PURPOSE To compareneuromuscular activity in CSM patients to healthy, age-matched controls. STUDY DESIGN/SETTING Nonrandomized, prospective, concurrent control cohort study. PATIENT SAMPLE Forty patients with symptomatic CSM prior to any surgical intervention and 25 healthy controls. OUTCOME MEASURES Integrated electromyography (iEMG), peak EMG, time to peak EMG, mean power frequency and time of muscle onset. METHODS Forty patients with symptomatic CSM prior to any surgical intervention and 25 healthy controls had neuromuscular activity measured during a series of over-ground gait trials at a self-selected speed. External Oblique (EO), Multifidus (Mf), Erector Spinae (ES), Rectus Femoris (RF), Semitendinosus (ST), Tibialis Anterior (TA), Medial Gastrocnemius (MG) and Medial Deltoid (MD) were assessed. Differences in integrated electromyography (iEMG), peak EMG, time to peak EMG, mean power frequency and time of muscle onset were assessed using one-way ANOVA. RESULTS Compared to controls, patients with CSM demonstrated significantly less activation amplitude of the EO (0.72±0.79 vs. 1.52±2.05mV; p=.034), ST (3.02±5.37 vs. 5.86±9.19mV; p=.05), and MD (0.876±0.81 vs. 2.6±3.77mV; p=.008). They demonstrated significantly higher peak EMG muscle activity in the MD (0.06±0.044 vs. 0.03±0.021mV; p=.031) and significantly longer time to peak EMG muscle activity in the Mf (20.2±8.5 vs. 16.8±8.9ms, p=0.050), ES (18.2±6.7 vs. 8.9±7.2ms; p<.001), ST (26.3±7.2 vs. 22.4±6.8ms; p=.037), TA (14.7±7.4 vs. 11.0±7.4ms; p=.050) and MD (24.2±8.5 vs. 9.2±6.6ms p<.001). There was no difference in time of onset of muscle activity during gait. CONCLUSIONS Patients with CSM often present with a gait disturbance that has significant implications on quality of life. This study's findings demonstrate difficulty with muscular recruitment in lower extremity stabilizing musculature, coupled with increased peak EMG activity in the MD, representing compensatory mechanisms in the upper extremities, as well. This study contributes to existing knowledge on EMG muscle activity in patients with untreated CSM and will be useful in future studies investigating neuromuscular function in patients with CSM after surgical decompression. [ABSTRACT FROM AUTHOR]

Patient reported outcome measures (PROMs) are commonly used to indicate functional status however, there is a lack of published literature on their relation to objective functional outcome measures (FOMs) among adult spinal deformity (ASD) patients. The minimum clinically important difference (MCID) is often used among spine PROMs as the standard benchmark by which outcome success is gauged however there is no data currently available describing the relation of PROM MCIDs to concurrent changes in FOMs for ASD surgery patients. Additionally, it is currently unclear whether PROMs are suitable for serving as anchors for determining FOM MCIDs. To determine if achievement of PROMs MCID coincides with significant changes in objective walking and balance FOMs among ASD patients treated with realignment surgery at 3- and 12-month follow-ups. Nonrandomized, retrospective review of ASD patient PROM and FOM data before and after realignment surgery. A total of 80 patients treated with spinal fusion for ASD. Visual analog scales (VAS) for mid-back, low-back and leg pain, Oswestry Disability Index (ODI), Scoliosis Research Society SRS-22r, spatiotemporal and kinematic gait measures, and postural balance measures. ASD surgery patients who completed PROMs and functional evaluations one week before (P0) and at three (P3) and 12 (P12) months after surgery were included. Functional evaluations included walking and standing tests using three-dimensional motion tracking. FOMs which showed significant univariate P0-P3-P12 improvements were grouped and compared by achievement of MCID (aMCID=yes, nMCID=no) at P0-P3 and P0-P12 for each PROM using independent sample t-tests. All PROMs showed significant univariate improvements (P0, P3, P12 respectively): VAS middle-back (4.4±2.8, 1.9±2.4, 1.8±2.6, p<0.001), VAS low-back (5.6±2.9, 2.7±2.6, 2.3±2.9, p<0.001), VAS leg (4.7±3.6, 1.8±2.8, 1.7±2.6, p<0.001), ODI (40.4±15.5, 29.7±21.4, 22.9±22.3, p<0.001), SRS-22r (2.9±0.5, 3.4±0.8, 3.9±0.9, p<0.001). Three of 14 gait FOMs showed significant univariate improvements: walking speed (0.87±0.18m/s, 0.92±0.12m/s, 0.96±0.16m/s, p=0.024), single-support time (0.44±0.06s, 0.44±0.06s, 0.41±0.06s, p=0.031), and gait deviation index (75±11.2, 68.8±13.7, 80.6±16.3, p=0.003). MCID achievement was as follows: VAS middle-back (55% at P3, 67% @P12), VAS low-back (74% @P3, 76% @P12), VAS leg (55% @P3, 62% @P12), ODI (46% @P3, 51% @P12), SRS (43% @P3, 82% @P12). No significant pairwise differences were found for any FOMs when grouped by MCID achievement status for each PROM. Achievement of MCID for ASD PROMs commonly associated with function did not coincide with significant differences in FOMs that otherwise did show consistent improvements at P3 and P12 follow-ups. Improvements in FOMs with a lack of separation by PROM MCID suggests that PROMs and FOMs may be measuring different aspects of changes in functional status of ASD patients and may require different methods for determining clinical relevance. PROMs used for assessing ASD patient function may not be suitable anchors for determining clinical FOM benchmarks. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

• Minimally invasive lumbopelvic fixation for unstable sacral fractures is a significant advance. • For polytraumatized patients, minimally invasive lumbopelvic fixation can be performed without significant physiologic consequences. • Lumbopelvic instrumentation without fusion successfully manages sacral fractures, improving patient-reported outcomes (PRO). • The combination of percutaneous instrumentation without arthrodesis did not result in any fracture non-union. Historically, fractures causing lumbopelvic dissociation have been managed with open lumbosacral fusion and instrumentation. Our aim was to evaluate outcomes and complications following surgical management of unstable transverse sacral fractures with percutaneous lumbopelvic fixation. Design : Retrospective case series. Setting : Academic Single Center, Level I Trauma Center. Patient Selection Criteria : Patients with lumbopelvic dissociation undergoing surgery. Outcome Measures and Comparisons : Patient demographics, mechanism of injury, ISS, associated injuries, radiographic classification (Roy-Camille), patient-reported outcomes (PROMIS PI, PF, D, and ODI), and complications were collected. 27 patients were enrolled with an average follow-up of 18.7 ± 17.6 months and age of 54.4 ± 25.1 years. All patients underwent lumbar pedicle screw and iliac screw placement. Sacral laminectomy was performed if the patient had a preoperative neurological deficit. Patients were counseled on instrumentation removal at 6–12 months. 67 % of patients sustained a fall, and 33 % were involved in an MVA. 52 % were Roy-Camille Type 2, and 32 % and 20 % were Types 1 and 3, respectively. The mean EBL was 261 ± 400 ml. 37 % required concurrent sacral laminectomy. There were no intraoperative complications and four postoperative complications, including surgical site infection, rod dislodgment, and deep venous thrombosis. 63 % underwent removal of instrumentation after fracture healing. ODI scores significantly improved from 6 weeks post-op (35.5 ± 4.5) to one-year follow-up (18.3 ± 9.6, p = 0.005), two-year follow-up (20.3 ± 10.0, p = 0.03), and final follow-up (16.4 ± 8.8, p = 0.002). Statistically significant improvements were observed in the PROMIS PI, PF, and D domains (p < 0.05). Our study demonstrates that lumbopelvic instrumentation leads to successful management of unstable transverse sacral fractures, with improvement in PRO. The combination of percutaneous instrumentation without arthrodesis did not result in any fracture non-union. Level IV [ABSTRACT FROM AUTHOR]

Background Context: Surgical correction strategies for adult spinal deformity (ASD) relies heavily on radiographic alignment goals, however, there is often debate regarding degree of correction and how static alignment translates to physical ability in daily life. Kinematic analysis has the potential to improve the concept of ideal spinal alignment by providing clinically meaningful estimates of dynamic changes in spinal alignment during activities of daily life.Purpose: Estimate representative dynamic ranges of spinal alignment during gait among ASD patients using 3D motion tracking; compare dynamic alignment between mild and severe deformity patients and to healthy adults.Study Design/setting: Retrospective review at a single institution.Patient Sample: Fifty-two ASD patients and 46 healthy adults.Outcome Measures: Radiographic alignment, kinematic spine motion, spatiotemporal gait measures, patient reported outcomes (VAS pain, ODI, SRS-22r).Methods: Spinal alignment was assessed radiographically and during standing and overground walking tests. Dynamic alignment was initialized by linking radiographic alignment to kinematic alignment during standing and at initial heel contact during gait. Dynamic changes in maximums and minimums during gait were made relative to initial heel contact for each gait cycle. Total range-of-motion (RoM) was measured for both ASD and healthy subjects. Dynamic alignment measures included coronal and sagittal vertical axes (CVA, SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), and pelvic tilt (PT). ASD patient's deformities were classified as either Mild or Severe based on the SRS-Schwab ASD classification.Results: Severe ASD patients had significantly larger dynamic maximum and minimums for SVA, TPA, LL, and PT (all p<.05) compared with Mild ASD patients. ASD patients exhibited little difference in dynamic alignment compared with healthy subjects. Only PT had a significant difference in dynamic RoM compared with healthy (p<.001).Conclusions: Mild and Severe ASD patients exhibited similar global dynamic alignment measures during gait and had comparable RoM to healthy subjects except with greater PT and reduced spatiotemporal performance which may be key compensatory mechanisms for dynamic stabilization. [ABSTRACT FROM AUTHOR]

• Finite element (FE) method is used to study three different types of screw–bone connections. • Both the spinal implants and the bone are subjected to higher stress right after the pedicle-screw-instrumented surgery. • Holding capability is smaller and the bone and implants are subjected to larger von Mises stress in the contact connection than those in the bonded connection. • Considerable differences were observed between simplified and non-simplified screw FE models in the von Mises stress. Finite element (FE) method has been widely used to study the screw–bone connections. Screw threads are often excluded from the FE spine model to reduce computational cost. However, no study has been conducted to compare the effect of such simplification in the screw models on the predicting accuracy of the model. The effects of different screw–bone connection types on the overall spine biomechanics are also unknown. In this study, three different types of screw–bone connections were compared using FE simulations in this study: (1) screw and bone are not fully bonded (contact connection); (2) screw is rigidly bonded with the bone (bonded connection); and (3) simplified-geometry-rigid (SGR) connection. Screw pullout test and physiological spinal loading test were simulated for the screws in this study: (1) pullout test where the pedicle screws were inserted in polyurethane foam; and (2) physiological spinal loading test (flexion, extension, lateral bending, and axial rotation) where the screws were fused into previously-validated FE lumbar spine model. The FE spine model used in this study included L 1 –L 5 spine levels and simulated major ligaments and resultant muscle forces. This study indicated that the holding capability in the screw–bone interaction is smaller and the bone and implants are subjected to larger von Mises stress (up to 44.88%) in the contact connection than those in the bonded connection. Among the four spinal loading cases tested in this study, flexion produced the highest von Mises stress in both the bone and the implants. Considerable differences were observed between simplified and non-simplified screw FE models in the von Mises stress at screw–bone contact region within spinal loading environment and the ultimate screw pullout strength in pullout test. This study concluded that both the spinal implants and the bone are subjected to higher stress immediately after the pedicle-screw-instrumented surgery and before the screw and bone are fully bonded. The screw–bone interface is less likely to fail after the screw and bone are fully bonded. SGR screw model is able to predict screw force and rod stress that are consistent with those predicted by non-simplified screw models. [ABSTRACT FROM AUTHOR]

Highlights • Fusing more spinal segments might help distribute the spinal load on the PS. • Fusing more spinal segments could reduce the stress in each individual PS. • The load on the rod remains similar during identical spinal load by fusing more segments. • Distributing the load from the spinal fixation device on more PSs will help reduce the stress for each individual PS. Abstract This paper examines the stress distribution in the posterior fusion fixation, spinal range of motion (ROM), and the screw–bone interaction force obtained from various fixation methods of short-segment spine surgical alignment (SA) under five loading conditions (axial compression, flexion, extension, lateral bending, and axial rotation) provided by a FE spine model. The implant-instrumented FE spine model was validated against the experimental data in the literature. Among different fixation methods, fusing more spinal segments might help distribute the spinal load on the pedicle-screw to reduce the stress, screw force, and instability of the spine (range of motion). With longer rods, the additional intermediate screws are suggested to provide additional anchoring effect to the fixation device. However, the fact that inserting more screws also increases the stress concentration points on the rods should also be considered. Further this study supports the clinical observation that interbody cage can provide anterior support to the spine and reduce the loads on the posterior fixation devices. In both single-level and two-level fusion, IB reduced ROM, rod stress, and screw/bone interaction force. [ABSTRACT FROM AUTHOR]

Patient reported outcome measures (PROMs) benchmarked by the minimum clinically important difference (MCID) are often used to indicate patient functional status before and after surgery for degenerative lumbar pathology (DLP). Prior research has shown that not all spine PROMs directly relate to objective functional improvements in activities like walking and standing. Currently it is unclear whether achieving PROMs MCID should be considered outrightly indicative of improved functional outcomes measures (FOMs). Determine if achievement of PROMs MCID relates to significant changes in objective gait and balance FOMs among surgical DLP patients. Non-randomized, retrospective review of DLP patient pre- and postoperative PROM and FOM data. There were 99 patients treated with decompression or single-level fusion for DLP. Visual analog scales (VAS) for low-back and leg pain, Oswestry Disability Index (ODI), spatiotemporal and kinematic gait measures, and postural balance measures (range-of-sway: ROS, total-sway distance: TSD). Surgical DLP patients completed PROMs and functional evaluations one week before surgery (P0) and at three- and 12-month postoperative follow-ups (P3 and P12). Functional evaluations included walking and balance tests using three-dimensional motion tracking. FOMs showing significant P0-P3-P12 univariate improvements were compared between achieved MCID (aMCID) and not achieved MCID (nMCID) for each PROM at P0-P3 and P0-P12. All PROMs showed significant univariate improvements (P0, P3, P12 respectively): VAS low-back (4.2±3.7, 1.7±1.7, 2.5±2.9, p=0.002), VAS-leg (5.8±3, 1.4±1.9, 1.6±2.6, p<0.001), ODI (43.4±13.6, 23.9±15.8,22.9±17.1, p<0.001). Two of 14 gait FOMs showed significant univariate improvements: increased step length (0.54±0.05m, 0.56±0.04m, 0.57±0.04m, p=0.043) and reduced single-support time (0.45±0.07s,0.44±0.06s, 0.42±0.04s, p=0.040). Three of six balance FOMs showed significant univariate improvements: reduced coronal ROS (2.95±2.19cm, 1.88±0.9cm, 1.9±0.73cm, p=0.025), reduced sagittal ROS (6.58±2.58cm, 5.5±1.72cm, 5.16±1.56cm, p=0.025), and reduced TSD (71±45.4cm, 50.3±19cm, 48±14.2cm, p=0.014) for the head. MCID achievement was as follows: VAS low-back: 67%@P3, 46%@P12; VAS leg: 73%@P3, 75% @P12; ODI: 58%@P3, 72%@P12. aMCID yielded significantly greater improvements in the following FOMs (aMCID/nMCID respectively): @P3: longer step length for VAS leg (0.03±0.03m/-0.01±0.05m, p=0.021), less coronal head ROS for VAS low-back (-1.59±3.19cm/-0.09±1.67cm, p=0.016) and VAS leg (-1.54±3.07cm/0.07±1.75cm, p<0.001), less sagittal head ROS for VAS leg (-1.94±4.1cm/-0.9±3.43cm, p=0.003), and less head TSD for VAS leg (-26.17±53.17cm/-8.54±32.57cm, p=0.002); @P12: less sagittal head ROS for ODI (-1.63±4.44cm/-0.71±2.38cm, p=0.046). Although significant, relative numeric improvements were minimal for head ROS. Select statistically significant differences in FOMs were found however, numerical differences were low and widespread improvements across all FOMs were not found, even with significant univariate improvements. Achieving MCID for VAS leg pain may be related to improved step length and dynamic balance, but there is little evidence to suggest that it should be considered indicative of overall functional improvement of DLP surgery patients. PROMs and FOMs may be measuring different yet equally important aspects of DLP patient function. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

The sacroiliac joint (SIJ) is an underappreciated pain generator in 15-30% of patients with low back pain. The SIJ functions as a primary structure which transfers loads of the upper body to the lower extremities. Sacroiliac joint dysfunction (SIJD) is characterized by SIJ laxity with symptoms manifesting primarily as low back and lower extremity pain. Additionally, there is growing evidence that gait patterns may also be affected by SIJD. Although there is still much controversy, minimally invasive sacroiliac fusion (SIF) is gaining interest as a procedure for SIJD patients with unremitting pain. SIF aims to reduce SI pain by stabilizing the SIJ and improving structural support between the sacrum and ilium. While positive outcomes for improved pain and reduced opioid consumption have been associated with SIF, there is a lack of research concerning the effects of SIF on functional biomechanics such as gait performance. To quantify the effects of SIF on biomechanical gait parameters of SIJD patients at three months postoperative follow-up compared to their preoperative state. Non-randomized, prospective, concurrent cohort study. Twelve symptomatic SIJD patients. Spatiotemporal parameters, gait range-of-motion (RoM) parameters, and patient-reported outcomes. Clinical gait analysis was performed one week before surgery (Pre) and three months after surgery (Post). Each patient performed a series of over-ground gait trials at a comfortable, self-selected speed. Data were collected using a motion capture system and three force plates. Back and leg Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Fear Avoidance Beliefs Questionnaire (FABQ), Tampa Scale for Kinesiophobia (TSK), and Demoralization Scale (DS) scores were also collected at both time points. Patients showed increased cadence (Pre: 98.39 vs Post: 106.95 steps/min, p=0.018) and walking speed (Pre: 0.87 vs Post: 1.03 m/s, p=0.013). Patients also showed decreases in stride time (Pre: 1.28 vs Post: 1.14 s, p=0.015), step time (Pre: 0.65 vs Post: 0.58 s, p=0.015), and double-support time (Pre: 0.37 vs Post: 0.29 s, p=0.024). Patients show significant decreases in both knee RoM (Pre: 15.25 vs Post: 10.79°, p=0.02) and head motion (Pre: 4.80 vs Post: 3.18 °, p=0.045) in the coronal plane. VAS leg pain score (Pre: 4.25 vs Post: 2.69, p=0.032) improved significantly postoperatively. SIJD patients treated with SIF showed significant improvements in functional gait and leg pain at their three-month follow-up. The results suggest that SIF provides improved lateral stability which in turn results in more efficient knee motion and improved cadence and step efficiency. The improved leg VAS scores reflect this notion as well. The lack of more pronounced improvements in gait and reported outcomes may be due to insufficient follow-up time to account for a full recovery following SIF. This study may serve as a basis for future diagnostic techniques which utilize gait pattern evaluation as an indicator for early development of SIJD. The findings of this study highlight the impacts that SIJD can have on patients daily lives and reinforces the importance of recognizing the SIJ as a contributor to the functional ability of an individual. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

BACKGROUND CONTEXT Adult degenerative scoliosis (ADS) patientscomprise a variety of conditions that affect the normal spinopelvic alignment in the coronal and or sagittal planes. In spinal deformity patients a variety of postural changes in the spine, pelvis and lower extremities are observed in their effort to compensate for the anterior shift in the gravity line. Spinal alignment surgery was found to improve balance and overall function. Balance is defined as the ability of the human body to maintain its center of mass within the base of support with minimal postural sway. Sway can be measure as the center of pressure (COP) movement when a person is standing in a static position. PURPOSE To investigate the effect of surgical alignment on postural sway in ADS patients both before and 3-months-after-surgery. STUDY DESIGN/SETTING Nonrandomized, prospective, concurrent control cohort study. PATIENT SAMPLE Eighteen ADS patients. OUTCOME MEASURES Center of pressure data. METHODS Each patient performed a series of functional balance tests one week prior (Pre) and 3 months postsurgery (Post). The functional balance test was similar to a Romberg's test in which the patients were asked to stand quietly with each foot on a force platform (ie, total two force platforms) in a self-selected posture with eyes open for a full minute. Force platform data were used to compute COP measures in both anterior-posterior (AP) and medial-lateral (ML) directions. Two postural sway assessment techniques were used for analysis: 1. traditional summary COP descriptive measures; and 2. invariant density analysis (IDA) which describes the dynamic COP distribution over time. IDA is known to be sensitive to capture the structural changes in human postural control system. For example, the zero-crossing measure (Zc) in the IDA tells how much the central nervous system (CNS) is actively involved in the control of the standing balance. A paired t -test was used to test the hypothesis (α=0.05) using SPSS. RESULTS Traditional measures and IDA included 32 (6×3×2) measures in three directions (ie AP, ML and radial directions). Ranges of COP in AP were Pre: 42.5±18.9 versus Post: 39.5±15.1 mm (p-value:.025) and mean velocities of COP in AP were Pre: 9.97±4.02 versus 9.62±4.28mm/s (p-value:.056). Surgical alignment revealed a significant decrease in the Zcfrom the IDA. The Zc in AP were Pre: 10.43±5.82 versus Post: 8.49±3.78mm (p-value:.050). The other variables did not detect the significant differences. CONCLUSIONS The smaller Zc from IDA postsurgery indicates that the surgical alignment prepares the human postural control system to have more active and robust balance. In other words, the CNS became more actively involved in the control of standing balance and thus the patients are recovering the standing balance after the surgical alignment. The only significant change in Zc and the insignificances from all the other measures suggest that 3 months after surgery may not be a sufficient time for ADS patients to fully recover. A long term follow-up is require. Objective motor performance measures will improve the evaluation and understanding of the biomechanical effects of spinal disorders on locomotion. [ABSTRACT FROM AUTHOR]

BACKGROUND CONTEXT Lumbar disc replacement (LDR) is used primarily to treat lumbar degenerative disc disease (DDD) resulting with back pain and/or leg pain in the absence of nerve root compression due to its advantages over fusion, including reduction of adjacent segment disease and reoperations as well as spinal motion preservation. A key factor of clinical success is rehabilitation. Physical therapy (PT) is often used to improve flexibility, strength and stability as well as balance and coordination, areas commonly deficient after surgery. Studies on PT and LDR are scarce. The impact of PT intervention on the neuromuscular, biomechanical, and self-reported outcomes of LDR patients' gait and balance have not yet been explored. PURPOSE To evaluate the effect of PT on the biomechanics of the lower extremities and spine during gait and balance in patients with DDD after LDR surgical intervention. STUDY DESIGN/SETTING A prospective concurrent control cohort study. PATIENT SAMPLE Eight LDR patients. OUTCOME MEASURES Gait spatiotemporal parameters and center of mass (COM) and head sway during functional balance test along with VAS and ODI. METHODS After LDR surgery, gait and functional balance analyses were performed the week before PT (pre) and after completion of 6-8 weeks PT (post). PT consisted of manual therapy, therapeutic exercises and activities as well as neuromuscular education per LDR protocol, which focused on improved mobility, stability and strength as well as balance in accordance with appropriate precautions or restrictions. No modalities, except for cold packs, were used. Spatiotemporal parameters (ie, gait speed, cadence, stride length, width and time, etc.) were calculated during the gait evaluation. The functional balance test was similar to a Romberg's test. COM and head displacements in the sagittal and coronal planes and total sway amount were calculated. ODI and VAS were collected on the day of each testing. RESULTS ODI score was reduced from 29.3±22.8 to 15.5±2.5. VAS leg (pre: 3.3±2.3vs. post: 0.6±0.5), and lower back (pre: 3.6±2.9vs. post: 1.4±0.3) scores were reduce as well. Patients presented with less COM say in the forward–backward direction (pre: 1.27±1.11vs. post: 0.21±0.87 cm), less external oblique muscle (pre: 0.028±0.020vs. post: 0.009±0.003 mV) but more rectus femoris (pre: 0.009±0.004vs. post: 0.012±0.005 mV) and tibialis anterior (pre: 0.009±0.002vs. post: 0.012±0.001 mV) muscle activity after completion of PT in comparison to their pre-PT state. Gait spatiotemporal parameters did not significantly change completion of PT. This may be due to the small sample size we have. CONCLUSIONS This is the first study to explore the effect of PT treatment on function in patients with DDD after LDR surgery. Minimal information is available on the effect of PT and LDR. PT after LDR surgery may positively affect the COM sway and improved muscle recruitment of the tibialis anterior and rectus femoris during balance resulting with a more stable, efficient, and normal balance pattern. Gait appears intact after LDR. More research and standardization of PT care is needed for optimal LDR benefits. [ABSTRACT FROM AUTHOR]

BACKGROUND CONTEXT Adult degenerative scoliosis (ADS) patients frequently suffer from impairments in mobility. Surgical intervention for ADS mostly improves gait, balance and other health-related quality of life scores. Previous literature demonstrates that the central nervous system (CNS) might use an organization of muscle synergies to control a wide range of activities, for example walking. Instead of controlling each muscle individually, the CNS groups the muscles and activates many them with a single control signal. Hence, neuromuscular synergies may indicate the ability of the CNS in generating independent control signals. Less number of muscle synergies during walking emphasizes inability of the CNS to generate as many independent control signals. The higher number of synergies represents the higher gait complexity since more number of control inputs are required to achieve the same task. PURPOSE To compare number of walking muscle synergies in ADS patients both before and 3 months postsurgery. STUDY DESIGN/SETTING A prospective concurrent control cohort study. PATIENT SAMPLE A total of 13 ADS patients. OUTCOME MEASURES Gait complexity by number of muscle synergies. METHODS Clinical gait analysis was performed one week prior and 3 months postsurgery. Five walking trials were performed at comfort speed. Surface electromyography (EMG) electrodes were placed and recorded bilaterally from 16 trunk and lower extremity muscles: external oblique, gluteus maximus, multifidus, erector spinae, rectus femoris, semitendinosus, tibialis anterior, medial gastrocnemius. EMG data was collected at 2,000 Hz, filtered, rectified, and normalized. The processed EMG was mathematically broken into synergies and their activation ratio (from 100%). The higher number of synergies always reduces the residual error between the reconstructed EMG and the original EMG. The required number of synergies were defined as the minimum number of synergies that could reconstruct EMG signals with subtracting 5% error ([EMGoriginal -EMGreconstructed] = e, e/EMGoriginal <5%). A paired t test was used to test the hypothesis (α=0.05) using SPSS. RESULTS Clinical gait analysis was performed one week prior and 3 months postsurgery. Five walking trials were performed at comfort speed. Surface electromyography (EMG) electrodes were placed and recorded bilaterally from 16 trunk and lower extremity muscles: external oblique, gluteus maximus, multifidus, erector spinae, rectus femoris, semitendinosus, tibialis anterior and medial gastrocnemius. EMG data was collected at 2,000 Hz, filtered, rectified and normalized. The processed EMG was mathematically broken into synergies and their activation ratio (from 100%). The higher number of synergies always reduces the residual error between the reconstructed EMG and the original EMG. The required number of synergies were defined as the minimum number of synergies that could reconstruct EMG signals with subtracting 5% error {(EMGoriginal -EMGreconstructed) = e, e/EMGoriginal <5%). A paired t test was used to test the hypothesis (α=0.05) using SPSS. CONCLUSIONS This study shows an increase in gait complexity by increase in number of synergies following a surgical alignment in ADS patients. More number of synergies postsurgery shows a more elaborate gait pattern since more number of synergies (modules) are required to rebuild the EMG signals, in addition to improvements in ability of the CNS in generating more number of independent or rich control signals. As an example, inability of poststroke patients in generating independent control signals for gait makes their CNS to activate numerous muscles with a single signal (at the same time), causing unwanted co-contractions that hinders their normal gait. We recommend that spine care providers use gait analysis as part of their clinical evaluation to provide an objective measure of function and to better understand the effects of the disease and its treatment on their patients' gait, function, and, ultimately, quality of life. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]