Postural adjustments in adolescent idiopathic thoracic scoliosis during walking

Introduction: Adolescent idiopathic scoliosis (AIS) is the most common type of three-dimensional spinal deformity. Identifying the postural adjustments or changes for different phases and events is needed for developing programs to improve the AIS gait, but such information has been limited. The current study aimed to fill the gap via three-dimensional motion analysis of quiet standing and level walking in patients with severe thoracic AIS. Materials and Methods: Sixteen female adolescents with AIS (Lenke 1 or 2, age: 14.9 +/- 1.7 years, height 154.7 +/- 5.0 cm, mass: 41.7 +/- 7.2 kg) and sixteen sex-, age- and BMI-matched healthy controls (age: 14.8 +/- 2.7 years, height 154.9 +/- 5.6 cm, mass: 44.7 +/- 6.3 kg) participated in the current study with informed written consent. The kinematic and kinetic changes between the trunk, pelvis, and lower limb segments, and at the lumbosacral level at different gait events were measured during quiet standing and level walking. Results: The homogeneity of the current patient group helped reduce the effects of the level and severity of spinal deformity on inter-subject variability that has been associated with controversies over reported gait variables in AIS. The current results support the hypothesis that postural adjustments involving the trunk, pelvis and lower limb segments were needed in severe thoracic AIS during both quiet standing and level walking, and differed between concave and convex sides at different key gait events during level walking. Conclusions: Although scoliotic spinal deformity occurred mainly in the frontal plane, postural adjustments in all three planes were present at key events during level walking with associated joint loading changes in patients with severe thoracic AIS. Monitoring of such adjustments and the associated joint kinetic changes will be helpful for assessing the disease and treatment outcomes.