# Reliability of Spino-Pelvic and Sagittal Balance Parameters Assessed During Walking in Patients with Back Pain

## TL;DR

This study shows that measuring spino-pelvic and sagittal balance during walking is reliable for patients with back pain, offering a dynamic alternative to static assessments.

## Contribution

The study introduces a dynamic method for assessing spino-pelvic and sagittal balance parameters during walking with high reliability in patients with back pain.

## Key findings

- Thoracic kyphosis angle and global tilt angle showed excellent reliability (ICC = 0.97 and 0.99).
- Dynamic assessment during walking is reliable despite minor marker inconsistencies and movement variations.
- Clinical application of this method could improve diagnostic accuracy and treatment planning for sagittal balance disorders.

## Abstract

This study aimed to establish and assess the reliability of spino-pelvic and sagittal balance parameters measured during walking in patients with back pain, some of whom had radiological signs of sagittal imbalance, reflecting real-world clinical conditions. Dynamic assessment offers an alternative to conventional static measurements, potentially improving the evaluation of sagittal balance. Ten patients aged 56–73 years completed a six-minute walking assessment while being monitored by the optoelectric Qualisys Motion Capture System. Forty-nine reflective markers were placed to measure the spino-pelvic and sagittal balance parameters across five gait phases: pre-walk, initial-walk, mid-walk, end-walk, and post-walk. Test–retest reliability was evaluated using the intraclass correlation coefficient (ICC). The results showed excellent reliability for thoracic kyphosis angle (ICC = 0.97), C7-L5 sagittal trunk shift (ICC = 0.91), and global tilt angle (ICC = 0.99); good reliability for auditory meatus-hip axis sagittal trunk shift (ICC = 0.85); and moderate reliability for pelvic angle (ICC = 0.57), lumbar lordosis angle (ICC = 0.72), and sagittal trunk angle (ICC = 0.73). Despite minor marker placement inconsistencies and variations in body movement across trials, the findings support the use of this dynamic assessment method in research settings. Its clinical application could also enhance diagnostic accuracy and treatment planning for patients with sagittal balance disorders, allowing for better-tailored therapeutic interventions.