Northwestern University Feinberg School of Medicine

Northwestern University Prosthetics-Orthotics Center

The Role of the Spine in Human Walking

Co-Principal Investigators: Steven Gard, PhD, and Aruna Ganju, MD**

Project Director: Pranitha Gottipati, PhD**

Co-Investigators: Stefania Fatone, PhD, and Rebecca Stine, MS

** Department of Neurosurgery, Northwestern University

Funded by: Medtronic Sofamor-Danek, Inc.; National Institutes of Health (NIH); training grant National Institute on Disability and Rehabilitation Research (NIDRR)

Status: In Progress

Purpose

The role that spinal motion plays during ambulation is not clearly understood. Little in vivo regional spinal motion data exists in the literature with regard to walking and most gait analysis models disregard the upper body altogether, or regard it as a single rigid structure. This study aims to increase understanding of the contribution of spinal motion during ambulation by improving the way spinal motion is modeled and measured. By increasing knowledge of the relationship between spine motion and restriction, and its impact on the rest of the musculoskeletal system in locomotion, a broader understanding regarding the implications of disease and treatment will be gained.

Methods

A kinematic model was developed and validated for the study of regional spinal motion concurrently with conventional gait data. Application of this model allowed for development of a foundation of able-bodied spinal motion patterns and ranges of motion during gait. Able-bodied subjects were also studied with and without imposed spinal restriction to gait an understanding of how restricted spinal motion affects kinematics during walking.To fully appreciate the effects of spinal restriction and true surgical spinal fusion on gait, subjects with spine deformity were studied before and after surgery.

Results

This research provides preliminary evidence that the spine has a more substantial role in gait than previously demonstrated. Support for the intended effects of spinal restriction in both able-bodied and pathological subjects was found. Temporal-spatial gait parameters improved after long fusion surgeries in a pathological population. The stance phase knee flexion-extension kinematics significantly improved after fusion surgery. Increased accelerations at the head and cervical regions with spinal restriction (in both able-bodied and pathological subjects) provide evidence of the spine's role in shock attenuation during gait. Additionally, both static and dynamic pathological alignment after surgical spinal restriction more closely resembled able-bodied alignment.

The knowledge gained from this research contributes to a more comprehensive understanding of human walking, spinal motion and the effects of surgical fusions on spinal alignment.

Publications

Gottipati P, Fatone S, Koski T, Sugrue P, Ganju A (2014) Crouch gait in persons with positive sagittal spine alignment resolves with surgery. Gait and Posture, 39:372-377. PMID: 24011797.

Konz R, Fatone S, Stine R, Ganju A, Gard S, Ondra S. (2006) A Kinematic Model to Assess Spinal Motion During Walking. Spine, 31(24):E898-E906. 17108818

Konz R, Fatone S, Gard S. The Effect of Restricted Spinal Motion on Gait in Able-bodied Persons. Journal of Rehabilitation Research & Development, 2006, 43(2):161-170. 16847783

Presentations

Gottipati P, Fatone S (2016) Segmental Spinal Motion before and after Spinal Reconstruction Surgeries. NUPOC Biennial Symposium for the German-Speaking Travel Fellows of Initiative ’93, February 25, Chicago, IL.

Gottipati P, Fatone S, Stine R, Ganju A (2013) Reduction in shock absorption capacity of the spine during gait after spinal reconstruction surgery (poster). Gait and Clinical Movement Analysis Society Annual Meeting, May 14-17, Cincinnati, OH.

Gottipati P, Fatone S, Stine R, Ganju A (2013) Reduction in Shock Absorption Capacity of the Spine during Gait after Spinal Reconstruction Surgery (poster). 9th Annual Lewis Landsberg Research Day, Northwestern University, April 4, Chicago, IL.

Gottipati P, Fatone S, Stine R, Ganju A (2013) Reduction in Shock Absorption Capacity of the Spine during Gait after Spinal Reconstruction Surgery. Northwestern University Postdoctoral Forum (NUPF), September 12, Evanston, IL.

Gottipati P, Fatone S, Ganju A (2012) Effect of fusion surgery on static and dynamic sagittal spinal alignment (poster). 47th Scoliosis Research Society, September 5-8, Chicago, IL.

Gottipati P, Fatone S, Stine R, Ganju A. (2011) Effect of Multi Segmental Spine Fusion Surgeries on Spine and Gait Kinematics (poster). Gait and Clinical Movement Analysis Society, April 26-29, Bethesda MD.

Gottipati P, Fatone S, Stine R, Ganju A. (2011) Effect of Multi Segmental Spine Fusion Surgeries on Spine and Gait Kinematics (poster). The 7th Annual Lewis Landsberg Research Day, Northwestern University, April 7, Chicago, IL.

Konz, Regina Jane (2007), "The Role of the Spine in Human Walking: Studies of Able-bodied Persons and Individuals with Spine Pathologies," PhD Dissertation, Biomedical Engineering, Northwestern University.

Konz R, Fatone S, Gard S, Ganju A and Ondra S. The Effects of Spinal Restriction on Walking: II. Lower Limb Data. Scoliosis Research Society. The 40th Annual Meeting, Miami, FL, October 27-30, 2005.

Konz R, Ganju A, Fatone S, Ondra S and Gard S. Non-invasive Measurement of Static and Dynamic Alignment. Congress of Neurological Surgeons, Boston, MA, October 8-13, 2005.

Konz R, Ganju A, Fatone S, Ondra S and Gard S. The Effects of Spinal Restriction on Walking: I. Regional Spinal Kinematics. The12th International Meeting on Advanced Spine Techniques, Banff, Canada, July 7-9, 2005.

Konz R, Fatone S, Gard S, Ganju A and Ondra S. The Effects of Spinal Restriction on Walking: II. Lower Limb Data. The12th International Meeting on Advanced Spine Techniques, Banff, Canada, July 7-9, 2005.

Konz R, Fatone S, Gard S. The Effect of a Thoraco-Lumbo-Sacral-Orthosis on Gait. The 31st Academy Annual Meeting & Scientific Symposium, Orlando, FL, March 16-19, 2005.

Konz R, Fatone S, Gard S. The Effect of a Thoraco-Lumbo-Sacral-Orthosis on Gait. The 11th World Congress of the International Society for Prosthetics & Orthotics, Hong Kong, August 1-6, 2004.

Konz R, Ganju A, Fatone S, Gard S and Ondra S. Non-invasive Measurement of Static and Dynamic Alignment: Preliminary Data. The 39th Annual Meeting of the Scoliosis Research Society, Buenos Aires, Argentina, September 6-9, 2004.

Konz R, Ganju A, Fatone S, Gard S, Ondra S. Non-invasive Measurement of Static and Dynamic Alignment: Preliminary Data. The 11th International Meeting on Advanced Spine Techniques, July 1-3, 2004 Fairmont Southampton, Bermuda.

Konz R, Fatone S, Gard S. The Effect of Thoraco-Lumbo-Sacral Orthoses on Gait. Gait and Clinical Movement Analysis Society. The 9th Annual Meeting, Lexington, KY, April 21-24, 2004.

Konz R, Stine R, Ganju A, Fatone S, Jorge A, Gard S, Childress D, Ondra S. Development of An Advanced Biomechanical Spine Model to Assess the Effect of Surgical Stabilization and Alignment on Gait. Congress of Neurological Surgeons 53rd Annual Meeting, Denver, CO, October 18-23, 2003.

Konz R, Stine R, Fatone S, Ganju A, Jorge A, Gard S, Childress D, Ondra S. Development of an Advanced Biomechanical Spine Model to Assess the Effect of Surgical Stabilization and Alignment on Gait. The 10th International Meeting on Advanced Spine Techniques, Rome, Italy, July 10-12, 2003.

Konz R, Stine R, Fatone S, Gard S, Childress D, Ganju S, Ondra S. An Advanced Biomechanical Model to Assess How Spinal Motion Contributes to Gait: Preliminary Data. Gait and Clinical Movement Analysis Society. The 8th Annual Meeting, Wilmington, DE, May 7-10, 2003.

Wireframe model of human walking

Wireframe model of human walking