Overview
The lecture distinguishes alignment from balance in spinal assessment, highlighting the need for both static and dynamic evaluations for optimal function and prevention of complications.
Alignment vs. Balance
- Alignment refers to the static position of the spine, while balance is dynamic and involves stability during movement.
- Radiographs (X-rays) show alignment, but advanced imaging like EOS provides horizontal and 3D perspectives for better assessment.
- Good static alignment on imaging does not guarantee optimal dynamic (functional) balance.
Evaluation Techniques
- EOS imaging enables assessment of the spine in different planes.
- Dynamic evaluations include force plate measurements and motion analysis for function and mobility.
- Local and global balance are interconnected and must both be considered.
Spine and Pelvis Compensation
- The pelvis plays a critical role in compensating for spinal imbalances.
- Human posture and balance rely on coordinated muscle, joint, and neurological factors.
- The "cone of economy" concept describes efficient upright posture with minimal energy use.
Neurology and Compensation
- Balance involves proprioception (body position sense), vision, and vestibular (inner ear) function.
- The brain integrates sensory inputs for posture and gaze stabilization.
- Humans naturally compensate for imbalance through orthopedic and neurological mechanisms.
Aging, Morphotypes & Adaptation
- Aging affects spinal alignment and pelvic motion, with decreased hip extension leading to compensatory changes.
- Incidence angle and spinal morphotype (shape) are genetically influenced and may change post-surgery.
- Ignoring mass distribution (head, torso, pelvis) leads to surgical planning failures.
Surgical Planning & Prevention
- Preoperative planning should consider compensation above/below fusion zones and mass, not just angles.
- Postoperative assessment needs dynamic evaluation, not only X-rays.
- Preventative strategies include preserving junctional (transition) vertebrae and maintaining hip extension reserve.
Practical Assessment & Rehabilitation
- Simple functional tests: walking speed, stair climbing, squatting, and performing tasks with a cognitive load (dual tasking).
- Dynamic measurements are important for older adults to time interventions before significant decline.
- Daily physical exercise, good nutrition, vision correction, proper footwear, and cognitive training help maintain balance.
Key Terms & Definitions
- Alignment — The static positioning of the spinal column.
- Balance — The dynamic ability to maintain stability during movement.
- EOS Imaging System — Advanced imaging technology for 3D spine visualization.
- Cone of Economy — Concept describing efficient, minimal energy upright posture.
- Incidence Angle — Measurement relating to pelvic orientation and spine morphotype.
- Compensation — Body's adaptation to maintain balance in response to changes or deficits.
Action Items / Next Steps
- Perform dynamic and functional assessments in addition to standard imaging for all patients.
- Encourage daily balance and strength exercises, especially in older adults.
- Use simple clinic tests: timed walking, stair climbing, squatting, and dual-task activities.
- Ensure proper surgical planning that includes evaluation of compensation and mass.
- Check and preserve hip extension reserve and junctional vertebrae in spinal procedures.