Impact of Fatigue on Maintenance of Upright Posture: Dynamic Assessment of Sagittal Spinal Deformity Parameters After Walking 10 Minutes

STUDY DESIGN.Retrospective analysis of prospectively collected data. OBJECTIVE.To assess global and regional spinal sagittal radiographic parameters in adults with loss of lumbar lordosis (“flatback”) before and after walking 10 minutes. SUMMARY OF BACKGROUND DATA.While routine activities of daily living may exacerbate functional disability of spinal sagittal-plane deformity, there is limited understanding of how sagittal parameters and compensatory mechanisms are affected by activity. METHODS.Consecutive adults with “flatback” at a single institution who previously had full-length standing spinal radiographs before and after walking 10 minutes were reviewed. Changes in spinal deformity sagittal parameters before and after walking were evaluated for two groupsCompensated Sagittal Deformity (“Compensated”SVA≤4 cm and PT>20) and Decompensated Sagittal Deformity (“Decompensated”SVA>4 cm and PT>20). Intra-group radiographic comparisons were performed with paired Student T-tests. RESULTS.157 patients (143 females, 14 males; average age 67.9 ± 5.9 years) met inclusion criteria. Initial average SVA was 1.7 ± 1.2 cm for “Compensated” and 11.5 ± 6.4 cm for “Decompensated”. After walking 10 minutes, significant deteriorations in average SVA were observed for all “Decompensated” patients and 84.6% of “Compensated” patients. For both groups, this was accompanied by significant decreases in PT and LL and increases in PI-LL (p