Prospective comparison in new challenging gait and balance tasks in female adolescents with idiopathic scoliosis before and following corrective spinal fusion

Patients with disturbed trunk symmetry, such as patients with adolescent
idiopathic scoliosis (AIS), have problems with stability control during
standing and walking. Often these patients require spinal fusion surgery, which
reduces the spinal mobility and affects the trunk biomechanics. So far, one
lacks appropriate quantitative measures to assess the functional outcome of
these interventions. At best, a simple gait analysis is performed using
standard methods (lower limb kinematics and the global spinal kinematics such
as acromion-pelvis (C7-S2) angle during simple level walking before and after
surgery). Nevertheless, it is essential to study the (functional) changes
induced by the surgery, since these are apparently tolerated very well. In
addition, one needs to learn how individual patients compensate for the fusion.
It is most likely that adjacent vertebrae have to compensate for the loss in
spinal mobility in AIS patients. Data of this type are clinically important
since this allows us to study the biomechanically important effects of the
number of fused vertebrae and the level of the fusion (thoracic or
thoracolumbar). Moreover, this will help clinicians in predicting and avoiding
additional problems that result from spinal fusion (e.g. adjacent segment
degeneration, junctional kyphosis, *adding-on*).

The aim of the present study is to use a more complete analysis of spinal
motion (using a 3D multi-segment spine model) and to introduce challenging gait
tasks which can optimally reveal the compensation strategies of the spine.
Furthermore, static balance will be investigated.

Patients in this experimental study will be tested before and after surgery in
demanding balance and gait tasks such as fast walking and walking uphill to
test their functional potential and to highlight compensatory strategies. The
measurements are non-invasive and also includes a questionnaire (SRS-22).

Patients will not be burden with excessive risks in case of participation, nor
with benefits. The additional measurements in the gait laboratory will be
performed, which will take some extra time. Patients are wearing a safety-belt
during walking on the treadmill. Furthermore, no additional visits to the Sint
Maartenskliniek will be necessary.
Participation of the patients is completely voluntary and patients have to sign
the informed consent procedure. Patients are allowed to withdraw the study at
any moment without reason. The privacy of the patients is protected with the
following measures: case report forms are filed under code number; all involved
investigators have professional responsibility not to compromise the
confidentiality of patient information. This is also stated in the patient
information. In reports, the patients will be presented anonymously.