Purpose: Body posture often deteriorates with aging due to degenerative spine disease, potentially leading to sagittal imbalance. In current clinical practice, sagittal balance is typically evaluated using radiological measurements in a standing position; however, these measurements do not always accurately reflect sagittal balance during movement. This study aimed to analyze sagittal balance dynamics during walking in older patients with degenerative spine disease and sagittal imbalance compared to a control group. Additionally, we aimed to investigate the agreement between dynamic measurements and changes observed in radiological assessments before and after walking, as well as identify predictive factors for sagittal balance deterioration during walking.
Methods: This prospective observational study included 33 patients with sagittal imbalance and 31 healthy controls. Radiological parameters were measured before and after six minutes of walking. During walking, dynamic measurements were performed using an optoelectronic motion capture system and surface electromyography (EMG) of trunk and lower limb muscles. Additionally, we analyzed body composition, muscle strength, and patient reported outcome measures (ODI, VAS, EQ-5D-5L).
Results: Radiological measurements after walking revealed statistically significant deterioration in all sagittal balance parameters, lumbar lordosis, and thoracic kyphosis among patients, while no such changes were observed in the control group. Measurements during walking showed substantial deterioration of sagittal balance during the transition from standing to walking, which was more pronounced in patients. No additional deterioration occurred on average during the walk itself, though notable worsening was observed in three individual patients. Changes in sagittal balance parameters during walking correlated closely with radiological changes measured after walking. Predictive factors associated with sagittal balance deterioration during walking included higher VAS scores, a subjective feeling of forward trunk inclination during walking, increased extracellular to total body water ratio, and specific radiological parameters (PI, SS, LL, PI–LL, SVA, CAM–HA, OD–HA, GT).
Conclusion: The most significant deterioration in sagittal balance in patients occurs during the transition from standing to walking, remains relatively stable during walking, and mostly returns to baseline after walking. The severity of degenerative spine disease is the main factor influencing sagittal balance deterioration during walking, with significant worsening only seen in a small number of patients. Given that radiological assessments performed after walking accurately reflect changes in sagittal balance during walking, incorporating such assessments into standard diagnostic evaluation could enhance the identification of patients at increased risk for sagittal balance deterioration during movement.
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