Sagittal spinal alignment in paraplegics: a new paradigm for the rehabilitation under neuromuscular electrical stimulation

• Published in: Spinal cord Vol. 48; no. 3; pp. 251 - 256
• Main Authors: Castro de Medeiros, R, Jaccard, A P B, Cliquet, A
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.03.2010; Nature Publishing Group
• Subjects: Adult; Anatomy; Anthropometry; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Cerebrospinal fluid. Meninges. Spinal cord; Electric Stimulation Therapy - methods; Human Physiology; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Kyphosis - pathology; Leg - physiology; Lordosis - pathology; Male; Medical sciences; Middle Aged; Muscle, Skeletal - innervation; Muscle, Skeletal - physiology; Nervous system (semeiology, syndromes); Neurochemistry; Neurology; Neuropsychology; Neurosciences; original-article; Paralysis - pathology; Paraplegia - rehabilitation; Posture - physiology; Radiography; Socioeconomic Factors; Spine - anatomy & histology; Spine - diagnostic imaging; Spine - physiology; Traumas. Diseases due to physical agents; spinal cord injury; paraplegic standing; sagittal spinal alignment; neuromuscular electrical stimulation; Nervous system diseases; Vertebral canal; Motor system disorder; Electrical stimulus; Alignment; Paraplegia; Spinal cord trauma; Central nervous system disease; Rehabilitation; Neurological disorder; Spinal cord disease
• ISSN: 1362-4393; 1476-5624; 1476-5624
• DOI: 10.1038/sc.2009.123

Study design: Radiographic analysis of sagittal spinal alignment of paraplegics in a standing position under surface neuromuscular electrical stimulation (NMES). Objectives: Describing the radiographic parameters of the sagittal spinal alignment of paraplegics going through a rehabilitation program with NMES. Setting: The University Hospital's Ambulatory (UNICAMP), Campinas, São Paulo, Brazil. Methods: Panoramic X-ray images in profile were taken for 10 paraplegics. All patients participated in the rehabilitation program and were able to perform gait through NMES of the femoral quadriceps muscles. The radiographic parameters used for the analysis were the same as those described in the literature for healthy people. The results were didactically organized into three groups: anatomical shape of the spine, morphology and kinetics of the pelvis and spinopelvic alignment. Results: The physiological curvature of the spine in paraplegics showed average values similar to those described in the literature for healthy patients. The inversion of the pelvic tilt and the increase in the sacral slope were defined by the anterior backward rotation of the pelvis. The existing theoretical mathematical formulas that define lumbar lordosis, pelvic incidence and pelvic tilt showed normal values, despite the anterior intense sagittal imbalance. Conclusions: The adaptive posture of the spine in paraplegics standing through the stimulation of the femoral quadriceps does not allow for a neutral sagittal alignment. This novel radiographic detailed description of the various segments of the spine can be of assistance toward the understanding of the global postural control for such subjects.