Effect of a semirigid thoracolumbar orthosis on gait and sagittal alignment in patients with an osteoporotic vertebral compression fracture

Figures & data

Table 1 Patient demographics at baseline

	Age (years)	Weight (kg)	Height (m)	BMI (kg/m^2)	Fracture level	T-score, BMD (g/cm^2)			T4–T12 kyphosis angle (°)	Wedge angle, vertebra (°)*	CCI
						Lumbar spine	Femur	Femoral neck
1	70	65.0	1.58	26.04	L3	−0.70 (0.999)	−0.30 (0.910)	−1.50 (0.686)	33.3	8.0	4
2	69	66.1	1.56	27.16	T12	−1.50 (0.918)	−0.60 (0.867)	−1.00 (0.741)	65.2	3.6	2
3	56	71.0	1.65	26.08	L2	0.20 (1.098)	0.20 (0.963)	−1.20 (0.718)	39.0	3.2	1
4	74	49.0	1.73	16.37	T11	−3.70 (0.676)	−2.50 (0.416)	−4.20 (0.384)	43.2	10.6	4
5	71	76.0	1.59	30.06	L4	−1.80 (0.877)	−2.10 (0.682)	−2.60 (0.557)	56.5	9.3	4
6	75	70.0	1.60	27.34	L1, L2	−0.20 (1.058)	0.70 (1.028)	−0.50 (0.799)	36.3	9.8	4
7	78	50.0	1.54	21.08	L1	−2.10 (0.845)	−0.60 (0.875)	−1.50 (0.686)	20.4	21	3
8	74	75.0	1.62	28.58	L1	−1.90 (0.873)	−1.50 (0.758)	−2.50 (0.577)	51.3	17.9	4
9	74	71.0	1.52	30.73	T12	0.00 (1.075)	0.10 (0.950)	−0.10 (0.840)	64.5	10.3	4
10	60	78.0	1.58	31.24	T11, L2	−1.00 (0.965)	−0.10 (0.926)	−1.60 (0.660)	46.0	6.1	2
11	65	82.0	1.51	35.96	L2	−0.70 (0.986)	−1.20 (0.799)	−1.60 (0.670)	23.1	10.0	3
12	70	68.0	1.60	26.56	L2	−4.40 (0.599)	−3.10 (0.560)	−3.70 (0.439)	56.5	5.0	3
13	70	88.0	1.68	31.18	L1	−0.80 (0.993)	−0.60 (0.874)	−1.20 (0.720)	53.9	10.6	4
14	74	58.0	1.62	22.10	L1	−2.70 (0.778)	−1.80 (0.719)	−2.70 (0.554)	32.5	14.9	3
15	55	60.0	1.70	20.76	L1	−3.50 (0.697)	−2.50 (0.633)	−2.50 (0.576)	42.6	9.0	1
Mean	69	68.5	1.61	26.75	–	−1.65 (0.896)	−1.06 (0.797)	−1.89 (0.640)	44.3	10.0	3.1
SD	7.0	11.0	0.06	5.03	–	1.41 (0.153)	1.14 (0.169)	1.13 (0.126)	13.8	4.9	1.1

Note:

* Each fractured vertebra was measured (angle formed between two lines drawn parallel to the superior and inferior end plates of the fractured vertebra).

Abbreviations: BMI, body-mass index; BMD, bone-mineral density; CCI, Charlson Comorbidity Index.

Table 2 Summary of the spatiotemporal and stability parameters, trunk motion, and stance phase knee flexion at baseline (mean + SD)

Gait	No brace (n=15)	Brace (n=15)	P-value
Stride length (m)	1.11+0.05	1.13+0.06	0.417
Speed (m/s)	1.07+0.12	1.13+0.17	0.109
Stride time (seconds)	1.11+0.05	1.13+0.06	0.140
Step width (m)	0.22+0.03	0.22+0.03	0.685
Cadence (steps/min)	108.99+5.42	106.78+5.26	0.156
Trunk motion (cm)	3.60+2.59	2.38+2.84	0.006*
Knee flexion (°)	7.37+6.87	6.76+6.02	0.305
Stability
MoS ML (m)	0.05+0.01	0.05+0.01	0.675
MoS AP (m)	−0.08+0.03	−0.07+0.03	0.882

Note:

* P<0.05 between walking with and without orthosis.

Abbreviations: MoS, margins of stability; ML, mediolateral; AP, anteroposterior.

Figure 1 Trunk motion over time. Higher values indicate more anterior position of the trunk in comparison to the pelvis.

Notes: (A) Trunk motion at baseline. Significantly more flexed posture without orthosis (P<0.05). (B) Trunk motion after 6 weeks wearing the orthosis showed no difference between walking with and without orthosis. (C) Trunk motion after 6 months, showing a pattern comparable to that found at baseline (P<0.05).

Table 3 Spatiotemporal and stability parameters, trunk motion, and stance phase knee flexion at the different time points (means ± SD)

Gait	T0 (n=11)	T1 (n=11)	T2 (n=11)	T0 vs T1 P-value	T0 vs T2 P-value	T1 vs T2 P-value
Stride length (m)	1.10±0.05	1.14±0.07	1.15±0.07	0.039*	0.007*	0.414
Speed (m/s)	1.09±0.10	1.24±0.21	1.30±0.23	0.004*	<0.001*	0.252
Stride time (s)	1.09±0.05	1.14±0.07	1.15±0.06	0.008*	0.003*	0.613
Step width (m)	0.22±0.03	0.21±0.02	0.20±0.03	0.255	0.041*	0.321
Cadence (steps/min)	110.67±5.06	106.19±6.17	105.05±5.70	0.011*	0.003*	0.524
Trunk motion (cm)	3.60±2.59	3.30±2.64	2.85±2.79	0.656	0.274	0.511
Knee flexion (°)	6.27±7.55	8.61±4.84	7.56±6.66	0.126	0.367	0.545
Stability
MoS ML (m)	0.05±0.01	0.04±0.01	0.04±0.01	0.077	0.137	0.760
MoS AP (m)	−0.10±0.03	−0.09±0.02	−0.09±0.03	0.148	0.045*	0.538

Note:

* P<0.05. T0, baseline; T1, 6 weeks after baseline; T2, 6 months after baseline.

Abbreviations: MoS, margins of stability; ML, mediolateral; AP, anteroposterior.

Figure 2 Radiographic sagittal balance. Graphs represent mean ± SD at each time point.

Notes: (A) GSA, significant improvement T0 versus T1 (P<0.001), relapse at T2. (B) GAP score, significant improvement T0 versus T1 (P=0.001), relapse at T2. (C) SVA, improvement T0 versus T1 (P=0.089), relapse at T2. (D) Wedge angle, significant increase at 6 weeks (*P<0.001) and 6 months (**P<0.001).
Abbreviations: GSA, global sagittal alignment; GAP, global alignment and proportion; SVA, sagittal vertical axis.

Figure 3 Pain and quality of life. Graphs represent mean ± SD.

Notes: (A) Statistically significant improvement in VAS score over time (T0 vs T1 P<0.001, T0 vs T2 P<0.001). (B) QUALEFFO 41 results. Statistically significant improvement over time in the QUALEFFO pain domain (T0 vs T1 P<0.001, T0 vs T2 P<0.001), physical function (T0 vs T1 P=0.001, T0 vs T2 P<0.001), and social function (T0 vs T1 P=0.091, T0 vs T2 P<0.001).
Abbreviations: VAS, visual analogue scale; QUALEFFO, Quality of Life Questionnaire of the European Foundation for Osteoporosis.