Neuroortopedia

Vertical Video-based Gait Analysis for Assessment of Transverse Plane Motion: Reliability and Validity in a Neuromuscular Population

2025-02-14T00:00:00Z

Vertical Video-based Gait Analysis for Assessment of Transverse Plane Motion: Reliability and Validity in a Neuromuscular Population Olleac, Ramiro; Centeno, Bernardo; Duffy, Clara; Nuñez, Marcos; Marcos José, Crespo; Barrios, Lucas M.; Davids, Jon R.; Kulkarni, Vedant A. Background: In the absence of 3-dimensional gait analysis (3DGA), assessment of transverse plane motion of the lower extremity from sagittal and coronal video has a high degree of error. We propose a standardized method through vertical video-based gait analysis (VVGA) to assess the position of the pelvis and lower extremity in the transversal plane. This study aims to evaluate the reliability and accuracy of VVGA compared with 3DGA for transverse plane kinematics. Methods: VVGA and 3DGA were obtained simultaneously on subjects between the ages of 6 and 35 referred to a motion analysis center. Gait Deviation Index (GDI) and Gait Profile Score (GPS) were used to estimate overall gait deviation of the subjects. Three raters at different levels of experience performed VVGA on all patients utilizing a standardized technique. Inter-rater and intrarater reliability was calculated using interclass correlation coefficients (ICC). Mean absolute difference (MAD) between VVGA measurements and 3DGA data was calculated for each body-segment. Results: Twenty-six patients (median age: 12 y, 61.53% male) with neuromuscular disorders participated in the study, with the majority (65%) having cerebral palsy. The mean GDI of the subject group was 80.7 and the mean GPS was 1082, indicating a neuromuscular cohort with significant gait deviations. Inter-rater and intrarater reliabilities were excellent, with ICC ranging from 0.94 to 0.99. The overall MAD between VVGA analysis and 3DGA was 4.90 degrees, indicating a clinically acceptable overall error. Segment-specific errors were 4.63 degrees for pelvis rotation, 5.35 degrees for hip rotation, and 4.70 degrees for foot progression. Conclusions: VVGA is an accurate and reliable method for assessing the transverse plane position of the pelvis, hip, and foot when utilizing a standardized method of collection and data analysis. Further study is required to assess whether this technique can be used for surgical decision-making or outcome assessment.

Tratamiento de la escoliosis neuromuscular, espasticidad y luxación dolorosa de caderas en un tiempo quirúrgico. Instrumentación espinopélvica, rizotomía y drezotomía.

2024-11-14T00:00:00Z

Tratamiento de la escoliosis neuromuscular, espasticidad y luxación dolorosa de caderas en un tiempo quirúrgico. Instrumentación espinopélvica, rizotomía y drezotomía. Duncan, Carlos César; Segal, Eduardo; Mantese, Beatriz; Couto, Juan Carlos Introducción La incidencia de escoliosis neuromuscular, espasticidad y luxación de caderas en pacientes con Encefalopatía Crónica No Evolutiva (ECNE) está descripta hasta un 80% en los casos más severos. El tratamiento de estas patologías es un desafío, principalmente cuando se combinan con diversas comorbilidades. El objetivo de este trabajo es presentar nuestra experiencia en el tratamiento multidisciplinario de la escoliosis neuromuscular y la luxación espástica dolorosa de caderas, en un solo tiempo quirúrgico. En nuestro conocimiento es la primera presentación de esta técnica combinada. Material y Método En estudio retrospectivo evaluamos 5 pacientes con un promedio de edad de 11,2 años al momento de la cirugía, con diagnóstico de ECNE, manifestada como una cuadriparesia espástica (GMFCS V), que presentaban escoliosis, espasticidad y luxación dolorosa de caderas, ambas con indicación quirúrgica. Todos los pacientes fueron tratados de manera multidisciplinaria en un solo tiempo quirúrgico. Realizando el tratamiento de la deformidad espinal con instrumentación y artrodesis espinopélvica, asociando la drezotomía y la rizotomía para el tratamiento del dolor y la espasticidad. Se midieron radiografías preoperatorias (PRE), postoperatorias (POP), el dolor y la espasticidad. Resultados Evidenciamos una significativa corrección de la deformidad, con una buena alineación y balance espinopélvico tanto en el plano coronal como en el sagital. La asociación de la rizotomía y drezotomía aportaron un muy buen manejo de la espasticidad y dolor en los miembros inferiores. La combinación de mejor alineación, manejo de la espasticidad y dolor generaron un alto impacto positivo en la calidad de vida de estos pacientes, facilitando la sedestación, higiene y rehabilitación. Conclusión Consideramos este abordaje multidisciplinario como una alternativa válida para el tratamiento de estos pacientes con altísima complejidad. Permitiendo un enfoque de tratamiento integral de la espasticidad y de las deformidades asociadas que comprometen notablemente la calidad de vida.

The 18-cm Thoracic-Height Threshold and Pulmonary Function in Non-Neuromuscular Early-Onset Scoliosis: A Reassessment

2021-11-19T00:00:00Z

The 18-cm Thoracic-Height Threshold and Pulmonary Function in Non-Neuromuscular Early-Onset Scoliosis: A Reassessment Johnston, Charles E.; Karol, Lori A.; Thornberg, David; Jo, Chanhee; Eamara, Pablo Background: Thoracic spine height is cited as a crucial outcome measure in the treatment of early-onset scoliosis (EOS) because of its reported relationship to pulmonary function tests (PFTs). An 18-cm threshold has been proposed, although this single parameter might be overly simplistic for cases of different etiologies and deformity magnitude. We aimed to reevaluate pulmonary function in patients undergoing corrective surgery, assessing the role of residual scoliosis as well as spine elongation. Methods: Patients undergoing EOS correction with a minimum of 5 years of follow-up since initial treatment were evaluated. Standard spirometry (forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1]) was correlated to deformity magnitude and T1-T12 height. Patients were compared by age at first surgery (<5 or ≥5 years), final thoracic height (≤18 or >18 cm), and percentage of predicted pulmonary function (<60% or ≥60%). Results: Twenty-nine patients (15 congenital, 11 syndromic, and 3 idiopathic cases) were tested at a mean of 8.5 years following initial surgery. Twenty-two patients (mean initial age, 4.8 years) had growth-sparing instrumentation, and 7 patients (age, 5.1 years) had definitive fusion performed. Age at initial surgery was not associated with a difference in PFT results at the time of follow-up, and both age groups had ominously low percentages of predicted pulmonary-function volumes (50% to 55%). Only 18 of the 29 patients achieved a T1-T12 height of >18 cm. Those with a thoracic height of ≤18 cm had similar percentage-of-predicted spirometry results at the time of follow-up as those with greater thoracic height, possibly because of increased deformity correction. Only 14 of 29 patients had spirometry of ≥60% of predicted volume at the time of follow-up. These 14 had slightly smaller curves and slightly greater T1-T12 heights but significantly better spirometry results than the 15 subjects with <60% of predicted volume. For those with a T1-T12 height of ≤18 cm, the residual Cobb angle negatively correlated with spirometry results. In those with a final T1-T12 height of >18 cm, spirometry did correlate with thoracic height, especially when residual deformity was ≥60°. Conclusions: Regardless of thoracic height of ≤18 or >18 cm, with residual curves of >50o, pulmonary function was ominously low in fully half of the patients, raising doubt about the value of this threshold as an EOS outcome parameter.

Gait disorders in patients with instrumented neuromuscular scoliosis

2019-04-23T00:00:00Z

Gait disorders in patients with instrumented neuromuscular scoliosis Duncan, Carlos César; Maenza, Sebastián; Schmid, Cecilia; Segal, Eduardo; Couto, Juan Carlos Introduction: The effect of spinal fusion on gait in patients with neuromuscular scoliosis continues to be a controversial issue, especially in patients where the spinal fusion extends to the pelvis. Objective: To evaluate the effect of spinal instrumentation in these patients. Methods: We evaluated 34 patients in a retrospective study. The mean age at surgery was 14±3 years and only ambulatory patients who presented neuromuscular scoliosis and non-progressing neurogenic pathology were included. The patients were surgically treated by posterior spinal fusion with or without extension to the pelvis. Preoperative (PRE) and postoperative (POP) Rx were measured. Ambulatory potential was clinically examined in all the patients, and 10 patients were assessed by full-gait analysis. Results: The minimum POP follow-up was 2 years (2006-2016). Nine patients were instrumented to the pelvis when the obliquity was greater than 15°; the remaining patients were treated using the same fusion-level criteria as those applied for idiopathic scoliosis. All patients maintained their gait, with improvements in coronal and sagittal balance, transfers and sitting skills, physical appearance, and in some cases, gait speed. Conclusions: Spinal instrumentation in ambulatory patients with neuromuscular scoliosis, including procedures with extension to the pelvis, provides adequate correction and preserves ambulatory function. Level of evidence III; Retrospective case control study.