Sagittal Spinal Alignment in People with Chronic Spinal Cord Injury and Normal Individual: A Comparison Study Using 3D Ultrasound Imaging

The aim of this study was to compare the sagittal spinal alignment of people with chronic spinal cord injury (SCI) with normal individuals and to determine whether transcutaneous electrical spinal cord stimulation (TSCS) could cause a change in the thoracic kyphosis (TK) and lumbar lordosis (LL) to re-establish normal sagittal spinal alignment. A case series study was conducted, wherein twelve individuals with SCI and ten neurologically intact subjects were scanned using 3D ultrasonography. In addition, three people with SCI having complete tetraplegia participated further to receive a 12-week treatment (TSCS with task-specific rehabilitation) after evaluation of sagittal spinal profile. Pre- and post-assessments were conducted to evaluate the differences in sagittal spinal alignment. The results showed that the TK and LL values for a person with SCI in a dependent seated posture were greater than those of normal subjects for: standing (by TK: 6.8 degrees +/- 1.6 degrees; LL: 21.2 degrees +/- 1.9 degrees), sitting straight (by TK: 10.0 degrees +/- 4.0 degrees; LL: 1.7 degrees +/- 2.6 degrees), and relaxed sitting (by TK: 3.9 degrees +/- 0.3 degrees; LL: 7.7 degrees +/- 1.4 degrees), respectively, indicating an increased risk for spinal deformity. In addition, TK decreased by 10.3 degrees +/- 2.3 degrees after the TSCS treatment, showing a reversible change. These results suggest that the TSCS treatment could be used to restore normal sagittal spinal alignment for individuals with chronic SCI.