Elsevier

Gait & Posture

Volume 54, May 2017, Pages 27-33
Gait & Posture

Full length article
Roussouly’s sagittal spino-pelvic morphotypes as determinants of gait in asymptomatic adult subjects

https://doi.org/10.1016/j.gaitpost.2017.02.018Get rights and content

Highlights

  • Relationship between spine sagittal alignment and gait was studied in asymptomatics.

  • Subjects with different alignment morphotypes had varying gait kinematics.

  • Subjects with Roussouly’s type 2 alignment had the most deviant gait kinematics.

  • Pelvic tilt during gait is not determined by radiographic pelvic tilt.

Abstract

Sagittal alignment is known to greatly vary between asymptomatic adult subjects; however, there are no studies on the possible effect of these differences on gait. The aim of this study is to investigate whether asymptomatic adults with different Roussouly sagittal alignment morphotypes walk differently. Ninety-one asymptomatic young adults (46 M & 45 W), aged 21.6 ± 2.2 years underwent 3D gait analysis and full body biplanar X-rays with three-dimensional (3D) reconstructions of their spines and pelvises and generation of sagittal alignment parameters. Subjects were divided according to Roussouly’s sagittal alignment classification. Sagittal alignment and kinematic parameters were compared between Roussouly types. 17 subjects were classified as type 2, 47 as type 3, 26 as type 4 but only 1 as type 1. Type 2 subjects had significantly more mean pelvic retroversion (less mean pelvic tilt) during gait compared to type 3 and 4 subjects (type 2: 8.2°; type 3:11.2°, type 4: 11.3°) and significantly larger ROM pelvic obliquity compared to type 4 subjects (type 2: 11.0°; type 4: 9.1°). Type 2 subjects also had significantly larger maximal hip extension during stance compared to subjects of types 3 and 4 (type 2: −11.9°; type 3: −8.8°; type 4: −7.9°) and a larger ROM of ankle plantar/dorsiflexion compared to type 4 subjects (type 2: 31.1°; type 4: 27.9°). Subjects with type 2 sagittal alignment were shown to have a gait pattern involving both increased hip extension and pelvic retroversion which could predispose to posterior femoroacetabular impingement and consequently osteoarthritis.

Introduction

Spinal deformities are common orthopedic problems in both children [1] and adults [2] which often affect the spine in all 3 planes. While the motive for treatment can be related to aesthetic considerations or pulmonary function deficiency [3], spinal anomalies have also been shown to affect gait and balance [4].

Previous studies based on gait analysis have shown a significant effect of frontal malalignment on the kinematics [5], [6], kinetics [7], muscle activation patterns [6] and spatio-temporal characteristics [5], [8] of gait. However, there has recently been increased emphasis on the importance of the restoration of physiological sagittal alignment during spine deformity treatment [9].

Normative sagittal alignment requires a harmonious relationship between cervical lordosis, thoracic kyphosis, lumbar lordosis and pelvic parameters. While the absolute values of each of these components can vary in a large range of normality, these parameters are correlated amongst each other in order to maintain proper alignment in healthy subjects [10]. Roussouly et al. suggested that normal sagittal alignment could be divided into 4 types that differ significantly between each other [11]. While previous gait analysis studies have shown a significant effect of sagittal malalignment on gait [7], [12], [13], [14], [15], [16], there are no studies on the relationship between the variations of normal alignment and gait in asymptomatic healthy subjects.

The aim of this study is to investigate whether asymptomatic healthy adults with different Roussouly sagittal alignment morphotypes walk differently. Our hypothesis was that the kinematics and spatio-temporal characteristics of gait differ between subjects with different sagittal alignment morphotypes.

Section snippets

Study design

This is a cross-sectional IRB approved study of the relationship between sagittal alignment and gait in young adult volunteers. The inclusion criteria were age between 18 and 28 years and no history of orthopedic surgery to either the spine, pelvis or lower limbs. Subjects were excluded if they presented any pain, including lower back pain, at the time of the study or if they had any musculoskeletal disease. Most subjects were students recruited at one of the faculties of our university. All

Subject demographics

Ninety-one asymptomatic young adults (46 men & 45 women), aged 21.6 ± 2.2 (18–28) years, were enrolled in this study.

Subject characteristics by Roussouly type

17 (18.7%) subjects were classified as type 2, 47 (51.6%) as type 3, 26 (28.6%) as type 4, and only 1 (1.1%) subject as type 1. Therefore, Roussouly’s type 1 was excluded from further analysis. The demographic and sagittal alignment characteristics of each Roussouly type are reported in Table 1. Type 4 subjects were significantly more overweight compared to type 2 subjects (BMI = 24.2

Discussion

In this study, the examination of the sagittal alignment and gait of 91 asymptomatic adults showed that subjects with different Roussouly morphotypes tend to have different gait kinematics but similar spatio-temporal characteristics of gait. Each sagittal alignment morphotype was associated with a gait pattern which varied from the two other morphotypes, suggesting that corridors of normality could be specific to sagittal alignment profiles.

Conflict of interest statement

No conflicts of interest.

IRB approval

This study has been approved by the institutional review board of our institution (number FM189/CE-HDF-285).

Acknowledgements:

This study was supported by the research council of the University of Saint-Joseph (grant number: FM189).

The study sponsors were involved in neither the study design, collection, analysis and interpretation of data nor in the writing of the manuscript; nor in the decision to submit the manuscript for publication.

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