3D Motion Analysis Reveals Gait/DHS Connection

Using powerful 3D motion analysis, a research team from Japan has uncovered a connection between extended walking by patients with adult spinal thoracolumbar deformity and dropped head syndrome (DHS).

The study, “Evaluation of dynamic spinal alignment changes and compensation using three-dimensional gait motion analysis for dropped head syndrome,” was published online on July 22, 2022, in the Spine Journal.

“Dynamic kinematic evaluation of spino-pelvic alignment during gait using three-dimensional (3D) motion analysis has been proposed for adult spinal thoracolumbar deformity. That is because conventional full-spine radiographs cannot be used to evaluate dynamic factors. However, dynamic changes in spino-pelvic alignment during gait for dropped head syndrome (DHS) have not been studied using this approach,” researchers wrote.

For their analysis, they focused on the dynamic alignment changes during gait in dropped head syndrome using three-dimensional motion analysis and electromyogram analysis.

The researchers discovered that cervical and thoracic anterior tilt increased during gait.

Overall, 19 patients with dropped head syndrome with neck pain and/or anterior gaze disturbance were included in the study. The researchers collected data on static spino-pelvic radiological alignment, dynamic spino-pelvic kinematic parameters, and electromyogram (EMG) data.

An increase of cervical anterior tilt during walking was significantly associated with decreased muscle activity in the cervical paraspinal muscles (r = 0.463, p = 0.05) and latissimus dorsi (r = 0.763, p < 0.01).

There were also significant correlations between a change in thoracic sagittal angle to pelvic angle and C7SVA (r = 0.683, p < 0.01) and LL (r = 0.475, p < 0.05). These findings suggest that a larger C7SVA and smaller LL were associated with increased thoracic anterior tilt during gait.

“The 3D motion analysis for DHS showed that cervical and thoracic anterior tilt significantly increased after extended walking, resulting in worsening of dropped head. Decreased muscle activity of the neck extensor muscles during gait suggests insufficient neck extensor muscle endurance, which was associated with increased cervical anterior tilt,” the researchers wrote.

They added, “Correction of the cervical spine alone would not be sufficient to improve dropped head in cases with increased thoracic anterior tilt during gait. The results suggest that C7SVA and LL are crucial parameters in the surgical strategy for DHS.”

Study authors included Kousei Miura, M.D., Ph.D., Hideki Kadone, Ph.D., Tomoyuki Asada, M.D., Kotaro Sakashita, M.D., Takahiro Sunami, M.D., Masao Koda, M.D., Ph.D., Toru Funayama, M.D., Ph.D., Hiroshi Takahashi, M.D., Ph.D., Hiroshi Noguchi, M.D., Ph.D., Kosuke Sato, M.D., Fumihiko Eto, M.D., Hisanori Gamada, M.D., Kenot Inomata, M.D., Kenji Suzuki, Ph.D., and Masashi Yamazaki, M.D., Ph.D., all from the University of Tsukuba, Ibaraki, Japan.