An integrated dynamic evaluation platform to support clinical decision-making in adult spinal deformity

Adult spinal deformity (ASD) is a prevalent clinical condition in the elderly, causing great burden on quality of life and functionality. Although conservative treatment serves as the first line treatment, evidence on physiotherapy in ASD is lacking. This can be explained by the standard evaluation of the patient with ASD, consisting of static radiographic imaging and patient-reported outcomes, which fail to objectively assess functional abilities. The aim of this project was to develop a novel dynamic evaluation platform, consisting of a function and balance scale and a motion analysis protocol, to objectively measure functioning and disability in ASD. First, a balance assessment scale, the Function Assessment scale for Spinal Deformity (FASD), was developed and tested on its psychometric properties. The second objective was to develop and validate a motion analysis protocol, including a novel subject-specific approach to measure dynamic spinal alignment. Also, the impact of marker placement error on marker-based spinal alignment estimation was investigated for the first time. After development, the platform was clinically validated and integrated with the standard ASD evaluation, by applying it on a sample of 60 patients with ASD, subdivided in three groups based on their spinal malalignment, and a group of 20 control subjects. 10 patients were assessed before and 6 months after spinal corrective surgery to explore the impact of spinal fusion on functional parameters. The results showed that patients with ASD, especially with sagittal malalignment, performed worse on FASD compared to controls, indicating decreased general function and balance. Motion analysis revealed that these patients adopted altered gait patterns, including crouch and stiff knee gait, and adopted impaired spinopelvic motion strategies during sit-to-stand. These functional impairments partially persisted 6 months after surgery, suggesting other underlying mechanisms beside the spinal deformity were present. Objective dynamic information, measured with the developed platform, increased our knowledge on the impact of ASD on functioning and disability. In the future this gained knowledge might contribute to the development of guidelines for conservative treatment, both in the pre- and post-operative setting, focused on the patient's functional impairments instead of merely their static, radiographic deformity.

Publication year:2021

Accessibility:Embargoed