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How Biomechanics Analysis is Playing a Role in the Treatment of Spine Patients with Severe Ankylosing Spondylitis

How Biomechanics Analysis is Playing a Role in the Treatment of Spine Patients with Severe Ankylosing Spondylitis

How Biomechanics Analysis is Playing a Role in the Treatment of Spine Patients with Severe Ankylosing Spondylitis

Written by Dr. Ram Haddas

NASS2015

Recently, the Texas Back Institute surgeons and the Spine Biomechanics Laboratory helped to treat a young man with ankylosing spondylitis. This young man, Haymanot, is 20 years old and lives in Ethiopia. He came to Texas Back Institute with the help of The American Jewish Joint Distribution Committee in order to have a surgery which would be too dangerous to have in his home country. I am incredibly excited to be a part of this amazing and powerful project as it is one more bridge between treating patients and science.

Ankylosing spondylitis is an inflammatory disease that can cause some of the vertebrae of the spine to fuse together. This fusing makes the spine less flexible and can result in a hunched-forward posture and if the ribs are affected, it can cause difficulty breathing. When we first met Hayamont if he stood as straight as possible, his chest and head would point to the ground.

 

Before photos of Haymanot

Haymanot_Before_Front  Haymanot_Before_Side

 

The Spine Biomechanics Laboratory

Mission:

The Spine Biomechanics Laboratory at Texas Back Institute Research Foundation (SBL@TBIRF) exists to investigate the biomechanical risk factors associated with spinal ailments in an effort to define the most appropriate and effective treatment options.

Values:

Those clinicians and scientists involved with SBL@TBIRF will be uncompromising in furthering the biomechanics related to the treatment of spinal pathology. They will make every effort to further the science and translate that knowledge into clinical advances.

Achievement Philosophy;

The Spine Biomechanics Laboratory at Texas Back Institute Research Foundation has established a multi-disciplinary team of investigators and clinicians, who initiate and implement studies related to their specific areas of interest.

Location:

The Spine Biomechanics Laboratory at Texas Back Institute Research Foundation is located in the facilities of the Texas Back Institute Plano office. The Laboratory is housed in a 900 square foot area and outfitted with state of the art; motion capture equipment, dynamic electromyography, forceplate sensor, and related computer hardware and software.

 

Before pictures of the gait analysis testing

 

 

The Surgery

The patient was severely disabled by a very advanced deformity, requiring surgical intervention. The patient had a complex spinal reconstruction done in 3 phases over 14 hours under a single anesthetic performed by Dr. Theodore Belanger. Phase 1: T11-L5 laminectomy with osteotomy at each level from T11-S1. This involved cutting the posterior bony elements of the fused spine at each level in order to “unfuse it”. Phase 2: Anterior release and lumbar interbody fusion of L4-5 and L5-S1 using hyperlordotic cages and bone graft, as well as anterior release of the L3-4 level. Phase 3: Final correction of lumbar spine with completion of the L3-4 osteotomy, compression of the multiple osteotomies and T5-Pelvis posterior spinal fusion with instrumentation, achieving a total of 84° of change in his alignment measured by static X-ray images 

After photos

Haymanot_After_Back  Haymanot_After_Side

Find a more detailed account of Haymanot’s story on the Texas Back Institute blog here

 

How Did the Spine Biomechanics Laboratory Help?

Gait analysis was performed one day prior to surgery and one month post-surgery. Fifty-one reflective markers were incorporated in order to collect full body three-dimensional kinematics. Ground reaction forces (GRFs) were measured using three force plates. Electromyography (EMG) data from bilateral external oblique (EO), internal oblique (IO), erector spinae (ES), multifidus (Mf) at the fifth lumbar (L5) spinal level, rectus femoris (RF), semitendinosus (ST), Tibialis Anterior (TA) and medial gastro (MG) were measured using preamplified surface electrodes. Outcome measurements included 3D head, neck, trunk, pelvic, hip, knee, and ankle joint angle, Ground Reaction Forces, joint moments and power, EMG muscle activity for lower extremity and trunk along with gait parameters. The combination of a careful clinical assessment and gait analysis can produce better results in surgery for our patients.

After photos of the gait analysis:

Sequence 05.Still001-2 Sequence 05.Still002-2

The Results

The gait analysis in our Spine Biomechanics Laboratory was able to produce objective evidence showing full body motion after spinal surgical correction in a dynamic activity. The analysis showed walking speed and cadence improved after surgery in this severe ankylosing spondylitis patient (Figure 1 & 2).

Walking Speed

Cadence

 

Haymanot’s trunk angle was 77° flexion before surgery and decreased to only 14° one month after the surgical correction. His neck angle reduced from 35° of extension to 16° and head orientation was at 40° at extension position and decreased to 2° (Figure 3).

 

Angels

One of the interesting elements of this severe case is it proves the human body adjusts to make your eyes level with the ground. Surprisingly, very limited adjustments came from the pelvis and lower extremity. If you add the trunk, neck and head angles you will end up at zero (77° of flexion in the trunk + -36° of extension in the neck + -40° of extension in the head) which means all of his adjustments came from the spine and head.

This patient is scheduled to visit us again for a 2 month post-surgical follow up. We are hoping to see even more improvement in his gait at that time.

Stay tuned for the full paper soon.

Texas Back Institute