Gait and Postural Stability Assessment in Children With Idiopathic Scoliosis Undergoing Posterior Spine Instrumentation
Condition: Scoliosis
MeSH terms: Scoliosis
Study type: Observational

Summary: 
      The goal of this study is to evaluate children and adolescents with idiopathic scoliosis who
      are undergoing spinal fusion using motion analysis, balance, and outcome questionnaires.
      Little research has been done to evaluate how different fusion levels impact walking
      patterns, range of motion, posture and balance following spine instrumentation in children
      with idiopathic scoliosis. Debate still continues whether posterior spinal instrumentation
      with the last instrumented vertebra at or above Lumbar 3 (L3) will provide sufficient spine
      correction, greater motion, and better posture and balance when compared to a child with
      instrumentation at Lumbar 4 (L4). Furthermore, how does the spine fusion endpoint (last
      instrumented vertebra) impact quality of life, participation, and impairment in children and
      adolescents with idiopathic scoliosis and how do they compare to healthy age-matched peers.
      The goal of this study is to compare these two end points using gait analysis, postural
      stability, and outcome tools with the hopes of providing better clinical care to children
      with idiopathic scoliosis.
    

Detailed description: 
      The study population will include sixty (60) children with idiopathic scoliosis who will
      undergo spine surgery and sixty (60) developing children "Control Group". Scoliosis patients
      will undergo a period of testing which requires three visits: pre-operative evaluation,
      one-year post-operative evaluation, and two-year post-operative evaluation. The Control Group
      will require one initial assessment. A total of 240 evaluations will be performed over a
      three-year period. We will evaluate the correlation among outcome tools and quantitative
      measures in order to determine how these instruments can be used more effectively for better
      treatment. Subjects and their parents will be fully informed of the nature of the study as
      well as the potential risk involved and sign the appropriate consent form. The study will be
      reviewed by the IRB and include HIPAA compliance. This will be accomplished during testing at
      the Shriners Hospital for Children- Chicago Motion Analysis Lab. All possible steps will be
      taken to assure the safety and convenience of the study participants. All subjects will be
      evaluated using clinical outcome tools (PODCI, SF-36) and will undergo quantitative 3-D
      motion analysis and postural stability assessment. Quantitative 3-D gait analysis will be
      done with our 14-camera Motion Capture system and passive reflective markers (Figure 3).
      Motion analysis will be performed with each subject walking at a comfortable and natural
      speed on the laboratory walkway. Passive markers will be attached to anatomic landmarks in
      standardized locations using double-backed tape. Marker coordinate data will be used to
      determine range of motion and joint angles.

      Four forceplates will be used to measure kinetic data and static balance. Postural stability
      testing will be performed on all subjects (Figure 4). We will evaluate responses to dynamic
      stability challenges that investigates motor and sensory control and adaptation to
      perturbations. Static (quiet standing) postural stability tests will be done on all subjects.
      A licensed physical therapist (PT) will perform the exam following the protocol of the
      Shriners Hospital for Children's motion lab.
    

Intervention name(s): posterior spine fusion
Intervention type(s): Procedure
Intervention description(s): vertebrae are fused to straighten a spinal curve
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Adolescents with idiopathic scoliosis that have a Cobb angle greater than 50 degrees.
      
Keywords: Scoliosis; gait; posture; balance