• Jun Ouchida, Hiroaki Nakashima, Sadayuki Ito, Naoki Segi, Ippei Yamauchi, Ryotaro Oishi, Yuichi Miyairi, Yoshinori Morita, Yukihito Ode, Yasuhiro Nagatani, Yuya Okada, Mikito Tsushima, Masaaki Machino, Kyotaro Ota, Hiroto Tachi, Yujiro Kagami, Ryuichi Shinjo, Tetsuya Ohara, Taichi Tsuji, Tokumi Kanemura, Shiro Imagama, and Adult Spinal Deformity Study Group of the Nagoya Spine Group.
• Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan.
• Eur Spine J. 2024 Oct 1; 33 (10): 383338413833-3841.

PurposeThis study aimed to clarify the relation between global spinal alignment and the necessity of walking aid use in patients with adult spinal deformity (ASD) and to investigate the impact of spinal fixation on mobility status after surgery.MethodsIn total, 456 older patients with ASD who had multi-segment spinal fixation surgery and were registered in a multi-center database were investigated. Patients under 60 years of age and those unable to walk preoperatively were excluded. Patients were classified by their mobility status into the independent, cane, and walker groups. Comparison analysis was conducted using radiographic spinopelvic parameters and the previously reported global spine balance (GSB) classification. In addition, preoperative and 2 years postoperative mobility statuses were investigated.ResultsOf 261 patients analyzed, 66 used walking aids (canes, 46; walkers, 20). Analysis of preoperative radiographical parameters showed increased pelvic incidence and pelvic incidence-lumbar lordosis mismatch in the walker group and increased sagittal vertebral axis in the cane and walker groups versus the independent group. Analysis of GSB classification showed a higher percentage of walker use in those with severe imbalance (grade 3) in the sagittal classification but not in the coronal classification. While postoperative radiographical improvements were noted, there was no significant difference in the use of walking aids before and 2 years after surgery (P = 0.085).ConclusionA significant correlation was found between "sagittal" spinal imbalance and increased reliance on walking aids, particularly walkers. However, the limitation of improvement in postoperative mobility status suggested that multiple factors influence the mobility ability of elderly patients with ASD.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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