{"paper_id":"1fa5b08c-34f6-4681-9d59-3bca599deb5f","body_text":"Quantifying Gait and Mobility in Severe Idiopathic Scoliosis with Inertial Measurement Technology | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Quantifying Gait and Mobility in Severe Idiopathic Scoliosis with Inertial Measurement Technology Pablo Ulldemolins, Jorge Morales, Pedro Rubio, Silvia Pérez, Miquel Bovea, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8206930/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Apr, 2026 Read the published version in European Spine Journal → Version 1 posted 9 You are reading this latest preprint version Abstract Background Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity in adolescents. Severe curves (> 40°) can alter spinopelvic balance and gait mechanics, although few studies have objectively quantified these effects. To analyze gait characteristics, pelvic mobility, and lumbopelvic motion patterns in patients with severe AIS compared to healthy controls using inertial measurement unit (IMU) technology, and to explore correlations between radiological and gait parameters. Methods A prospective study was conducted including 35 preoperative AIS patients (Cobb > 40°) and 34 age-matched healthy controls. Each participant underwent gait analysis using a single IMU (BTS G-Sensor) performing three standardized tests: Up and Go , Walk , and 6-Minute Walk . Radiological parameters (Cobb angles, pelvic incidence, tilt, and sacral slope) were recorded. Statistical comparisons were performed. Results AIS patients showed significantly greater accelerations during standing-up and sitting-down transitions and reduced trunk flexion–extension ranges ( p < 0.05). The control group exhibited greater gait symmetry and smaller pelvic tilt ranges. Gait speed and total distance in the 6-Minute Walk test were significantly lower in AIS patients ( p < 0.05). Conclusions Severe AIS alters lumbopelvic rhythm and gait kinematics, producing compensatory patterns characterized by increased pelvic mobility and reduced trunk flexion. IMU-based motion analysis enables objective and reproducible evaluation of these biomechanical changes, offering a valuable clinical tool for preoperative assessment and rehabilitation planning. adolescent idiopathic scoliosis gait analysis inertial measurement unit pelvic mobility lumbopelvic rhythm biomechanics spinopelvic balance 1. Introduction Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity in adolescents, affecting between 1–4% of the population under 18 years of age, with a predominance in females( 1 – 3 ). Currently, no identifiable cause of AIS has been established, although proposed theories include hormonal factors, growth disturbances, muscular imbalance, and genetic components. Only about 0.1% of AIS cases are considered severe, defined as curves greater than 40° ( 4 , 5 ) . In adults, spinal deformities trigger compensatory spinopelvic mechanisms. The most significant changes include increased pelvic tilt and greater knee flexion, which result in slower gait speed, shorter stride length, and increased joint stress due to activation of compensatory mechanisms( 6 – 9 ). In adolescents, compensatory mechanisms are less evident. Patients with AIS have been reported to exhibit asymmetric gait patterns, changes in pelvic orientation, restricted pelvic mobility, and less efficient walking. However, studies remain limited and mostly focus on moderate deformities (< 40º) ( 10 – 15 ). Moreover, data collection systems commonly used in the literature rely on specialized equipment, making study results difficult to compare and reproduce( 16 ). An innovative alternative for motion analysis is the use of inertial measurement units (IMUs). These devices are lightweight, versatile, and cost-effective compared to traditional laboratory systems. They allow objective and accurate recording of movement patterns through simple tests that can be performed directly in healthcare settings, without the need for complex equipment. Due to these advantages, IMUs have become a widely used tool in gait analysis and mobility assessment, particularly in the fields of orthopedic surgery and sports medicine ( 17 – 24 ) The aim of our study is to compare whether patients with severe AIS present changes in pelvic orientation, spinal mobility restriction, and asymmetric gait compared to a healthy age-matched control group using IMUs. Furthermore, we evaluate whether radiological variables associated with the deformity can explain differences in gait patterns. 2. Methodology 2.1 Study population A gait analysis study was conducted on 35 patients with AIS prior to surgery and compared with a control group of 34 healthy adolescents. All participants in the patient group were diagnosed with adolescent idiopathic scoliosis, presenting a primary thoracolumbar/lumbar curve according to the Lenke classification ( 25 ) with a severe Cobb angle (> 40°). Patients with congenital, early-onset, syndromic, or neuromuscular scoliosis, as well as those with cardiopulmonary disorders or conditions that could alter gait patterns, were excluded. All patients were treated at our center by the Spine Unit of the Hospital Universitari i Politècnic La Fe, Valencia. Each patient had worn a Boston-type brace for more than one year, in accordance with standard treatment protocols for adolescent idiopathic scoliosis ( 4 , 5 ). The control group consisted of 34 healthy adolescents with a similar gender distribution and age range, recruited from public schools in our region. To be included in the control group, participants had to be healthy adolescents aged 13–25 years with no history of medical conditions. The study protocol was approved by the Human Research Ethics Committee of Hospital La Fe (2024-0818-1). All procedures were conducted in accordance with the principles of the Declaration of Helsinki of the World Medical Association, and written informed consent was obtained from all participants prior to inclusion. 2.2. Clinical and Radiological Assessment Each patient was evaluated three months before surgery. At each assessment, body weight, height, and body mass index were recorded. Shoulder, scapular, waist, and hip asymmetry were evaluated, and the Adams forward bend test was performed to assess rib hump prominence. Overall spinal alignment and posture were also examined. A systematic neurological assessment was performed at each visit, following the most recent AIS clinical guidelines ( 4 ). Each patient underwent a full standing anteroposterior spinal radiograph before surgery. Curves were classified according to the Lenke classification ( 25 ). Radiographic measurements included coronal and sagittal Cobb angles, coronal and sagittal balance, clavicular asymmetry, pelvic obliquity, pelvic tilt (PT), pelvic incidence (PI), and sacral slope (SS). Skeletal maturity was assessed using the Risser scale, and flexibility of the minor curve was evaluated through a side-bending test. Curves were considered flexible if they decreased by at least 50% or presented a Cobb angle < 25° during bending. All assessments followed the latest AIS and spine surgery guidelines ( 4 , 5 ). 2.3. Gait Analysis Gait analysis was performed using a portable, noninvasive BTS G-Sensor device (BTS Bioengineering, Garbagnate Milanese, Italy) (weight = 28 g; dimensions = 70.5 mm L × 41 mm W × 19.2 mm H). The device includes a triaxial accelerometer with multiple sensitivities (2, 4, 6, 8, and 16 g) and sampling frequencies from 4 Hz to 1000 Hz, a triaxial gyroscope (250, 500, 1000, or 2000 °/s) with sampling frequencies between 4 Hz and 8000 Hz, and a 13-bit triaxial magnetometer (1200 µT) with a frequency above 100 Hz ( 26 ) The sensor was positioned near the body’s center of mass at the L5–S1 level, using double-sided medical-grade adhesive tape and an elastic belt for fixation. The X-axis of the sensor pointed in the anteroposterior (AP) direction, the Y-axis in the mediolateral (ML) direction, and the Z-axis vertically (VT) relative to the ground ( 26 ) Data were processed using BTS G-Studio® software (v2.8.16.1), which automatically segments gait cycles and extracts parameters based on validated protocols ( Up and Go, Walk and 6-minute ). The Up and Go test assessed functional mobility by measuring the total time required for the subject to stand up from a chair, walk three meters, return, and sit down again; this test was performed twice per participant ( 26 , 27 ). The Walk test consisted of walking seven meters back and forth, providing quantitative gait data such as cadence, walking speed, stride length, limb symmetry index, propulsion, and pelvic movements ( 26 ). In the 6-minute test participants walked continuously for six minutes along a 30-meter path back and forth, measuring total distance covered and walking speed ( 26 , 28 ). The Up and Go test has been used in previous studies to assess mobility and gait in AIS patients AIS ( 29 ). The Walk and 6-Minute tests are unobstructed gait protocols similar to those applied in earlier research ( ( 2 , 30 ). A second-order Butterworth filter with a cutoff frequency of 10 Hz was applied to minimize high-frequency noise. Gait cycles were segmented using vertical acceleration peaks to identify heel strikes, based on adaptive thresholding methods validated in previous IMU-based gait studies. The software calculated step-by-step metrics for each gait cycle. For each participant, the reported value of each parameter corresponds to the mean of all valid steps during straight-line walking. The gait analysis parameters collected in each test are summarized in Table 1 . Table 1 Variables of each test and their definitions. Variables Definition Test Up and Go Total (s) Overall time required to complete the Timed Up and Go test, including sit-to-stand, gait, turning, return, and stand-to-sit phases, reflecting global mobility and functional performance. SU_SD (s) Time interval needed to complete sit-to-stand and stand-to-sit transitions, indicating efficiency of postural change and control of sagittal plane motion( 31 ). SU_SD (m/s 2 ) Peak linear acceleration of the trunk or center of mass during sit-to-stand and stand-to-sit, representing the dynamic demand for muscle power and balance during transitional movements( 31 ). Spin velocity (º/s) Angular speed of trunk rotation during the turning phase of the Timed Up and Go test, quantifying dynamic stability and coordination of axial motion ( 31 ). SU_SD (ºmax) Maximum joint angles reached during sit-to-stand and stand-to-sit transitions, reflecting hip mobility and muscle control demands in the sagittal plane( 31 ). SU_SD range (º) Total angular excursion of the hip during sit-to-stand and stand-to-sit transitions, determined by the interplay between pelvic motion, thigh displacement, and postural requirements( 31 ). Test Walk Step-cadence (step/min) Number of steps taken per minute, reflecting the temporal rhythm of gait and commonly used as an indicator of walking speed and efficiency ( 31 , 32 ). L_R Step-length (m) Interval between initial contact of each foot, influenced by pelvic rotation during swing, which contributes to overall stride length ( 31 , 32 ) Simmetry index (%) Quantifies the symmetry of forward acceleration between limbs, calculated using normalized bilateral differences ( 33 ) Propulsion Measures the subject’s ability to propel the center of mass forward during the single support stance phase. Lower values may indicate impaired strength or propulsion asymmetry ( 34 ) 3D kinematics of the pelvis (º)(%) Includes the range (º) and symmetry index (%) of tilt, obliquity and rotation, derived from angular velocity data, allowing assessment of trunk control and limb coordination ( 31 , 32 ). Test 6-minutes Distance (m) Total distance covered while walking continuously for six minutes at a self-selected pace, reflecting submaximal functional exercise capacity, endurance, and efficiency of gait performance ( 31 ). Speed (m/s) Estimated using anthropometrically scaled stride length and step frequency, avoiding double integration of acceleration and minimizing drift using sensor fusion algorithms integrated into the IMU ( 20 ) * SU, standing-up; SD sit-down; L, left; R, right. 2.4. Protocol Gait analysis was performed on patients three months prior to surgical intervention. The assessment took place along a 30-meter corridor specifically designated for this purpose, both at the hospital center (for the AIS group) and at educational facilities (for the control group), ensuring identical space, surface, and measurement conditions in both settings. Participants were instructed to keep their gaze forward, avoid head rotations, and swing their arms naturally while walking. Before data collection began, each subject completed a 5-minute familiarization walk to ensure a spontaneous and stable gait pattern. 2.5. Statistical Analysis Statistical analysis was performed using IBM SPSS Statistics 25.0 (IBM, Chicago, IL, USA). Measurement results were expressed as mean ± standard deviation for each group. Normality was tested using the Kolmogorov–Smirnov test. For normally distributed data, independent-sample t -tests were used to analyze differences in symmetry and regularity variables between the control group and the preoperative AIS group. For non-normally distributed variables, the nonparametric Mann–Whitney U test was used. Categorical variables were compared using the Chi-square test. To assess bivariate correlations between gait parameters and radiological variables, Pearson’s correlation test was performed between the radiological parameters and the gait variables that showed statistically significant differences between AIS patients and controls. A p -value < 0.05 was considered statistically significant. 3. Results 3.1. Population Characteristics The study included a total of 35 AIS patients and 34 healthy controls. Demographic characteristics, including age, weight, and sex distribution, were similar between the AIS and control groups ( p > 0.05) (Table 2 ). Table 2 Mean value and standard deviation of subject characteristics Parameters AIS (n = 33) Healthy (n = 34) p-value Female rate (%) 90.9 88.2 .517 Age (year) 15.93 ± 4.47 17.38 ± 2.77 .117 Weight (kg) 54.80 ± 9.88 56.38 ± 10.62 .531 Height (cm) 161.24 ± 7.24 166.82 ± 8.10 .4 BMI (kg/m2) 21.01 ± 3.66 20.23 ± 3.10 .348 Notes. AIS, adolescent idiopathic soliosis; BMI, body max index. 3.2. Radiographic Characteristics of the AIS Group A total of 45.7% of patients with AIS were classified as Lenke type 1, followed by 31.4% classified as Lenke type 3 (Table 3 ). Most curves (94.2%) were right-sided and 21 (60%) demonstrated flexibility on radiographic bending tests. The mean Risser grade was 3.84 ± 1.03. The mean Cobb angle of the thoracic curve was 70.54 ± 16.06°, and that of the lumbar curve was 49.57 ± 21.68°. A detailed description of the group’s radiological measurements is presented in Table 4 . Table 3 Distribution of patients according to Lenke’s types Lenke N % Lenke 1 16 45.7 Lenke 2 2 5.7 Lenke 3 11 31.4 Lenke 4 1 2.9 Lenke 5 3 8.6 Lenke 6 2 5.7 Table 4 Mean value and standard deviation of radiological variables of AIS patients Variables AIS patients Range of normal values ( 3 – 5 ) Thoracolumbar curve (º) 70.54 ± 16.06 0 Lumbar curve (º) 49.57 ± 21.68 0 Coronal alignment (cm) 2.25 ± 4.71 < 2 Pelvic obliquity (º)º 1.91 ± 1.26 < 5 Shoulder imbalance 1.61 ± 1.33 0 Cervical lordosis (º) 14.97 ± 11.49 20–40 Thoracic kyphosis (º) 27.02 ± 13.62 20–50 Lumbar lordosis (º) 49.64 ± 14.41 40–60 Sagital vertical axis (mm) 3.39 ± 3.36 < 5 T10-L2 transition (º) 13.93 ± 9.02 < 10 SS (º) 37.82 ± 11.20 30–50 PI (º) 48.05 ± 13.16 40–60 PT (º) 9.61 ± 7.09 7–15 * SS, sacral slope; PI, pelvic incidence; PT pelvic tilt. 3.3. Gait differences between AIS patients and controls 3.3.1. Up and Go test Although no significant differences were found in the total duration of the test, distinct movement strategies were observed between groups (Table 5). AIS patients showed significantly higher accelerations during functional transitions of standing up and sitting down. Specifically, they exhibited greater horizontal acceleration when standing up (± 1.14 m/s²) and greater vertical acceleration when sitting down (± 1.62 m/s²) compared with the control group ( p < 0.05). Additionally, AIS patients demonstrated significantly reduced trunk flexion and extension peaks and ranges compared with healthy controls ( p < 0.05). 3.3.2. Walk test No significant differences were found between groups in cadence, step length, or propulsion (Table 5). However, the control group showed a significantly more symmetrical gait pattern and a smaller range of pelvic tilt ( p < 0.05) 3.3.3. 6-minute test The control group covered a greater distance and walked at a higher speed than the AIS group, with statistically significant differences ( p < 0.05). Table 5. Gait parameters between idiopathic scoliosis patients, healthy subject, and post-surgery patients Variables AIS Healthy p-value 1 Up and Go test Total (s) 9.63 ± 1.35 10.02 ± 2.27 .401 SU (s) 1.17 ± 0.32 1.19 ± 0.25 .833 SD (s) 1.24 ± 0.39 1.42 ± 0.30 .004* SU horizontal acc.(m/s 2 ) 4.63 ± 1.98 3.49 ± 1.05 .004* SD horizontal acc.(m/s 2 ) 5.12 ± 1.85 4.36 ± 1.74 .088 SU lateral acc. (m/s 2 ) 3,39 ± 1.57 2.88 ± 0.93 .115 SD lateral. acc. (m/s 2 ) 5.17 ± 1.58 4.24 ± 1.50 .016* SU vertical. acc. (m/s 2 ) 5.98 ± 1.82 5.57 ± 1.74 .351 SD vertical. acc. (m/s 2 ) 7.62 ± 2.61 6.00 ± 1.84 .005* Spin velocity (º/s) 213.72 ± 36.49 215.27 ± 33.40 .640 SU flexion peak (º) 31.08 ± 8,67 33.68 ± 9.44 .246 SU flexion range (º) 31.00 ± 8.67 33.32 ± 9.82 .038* SD flexion peak (º) 29.86 ± 9.12 34.87 ± 10.88 .046* SD flexion range (º) 16.43 ± 10.57 14.07 ± 11.70 .006* SU extension peak (º) 19.73 ± 6.94 24.46 ± 10.82 .309 SU extension range (º) 11.51 ± 8.42 9.12 ± 6.57 .200 SD extension peak (º) 7.18 ± 6.05 3.86 ± 3.25 .390 SD extension range (º) 26.08 ± 9.30 34.72 ± 10.32 .001* Walk test Step-cadence (step/min) 115.94 ± 9.35 113.81 ± 8.60 .336 L Step-length (m) 1.19 ± 0.22 1.26 ± 0.16 .116 R Step-length (m) 1.18 ± 0.21 1.26 ± 0.16 .118 Simmetry index (%) 92.51 ± 5.01 95.60 ± 2.79 .003* Propulsion 9.58 ± 2.27 9.09 ± 2.06 .359 Pelvic tilt simmetry (%) 65.97 ± 47.47 65.95 ± 22.50 .998 Pelvic tilt range (º) 6.33 ± 2.74 4.50 ± 2.52 .006* Pelvic obliquity simmetry (%) 94.31 ± 13.80 97.39 ± 2.33 .205 Pelvic obliquity range (º) 9.27 ± 3.19 8.79 ± 3.74 .569 Pelvic rotation simmetry (%) 90.18 ± 14.25 91.78 ± 25.36 .660 Pelvic rotation range (º) 12.57 ± 4.80 11.23 ± 5.37 .289 6-minutes test Distance (m) 421.16 ± 65.12 463.45 ± 35.66 .002* Speed (m/s) 1.31 ± .01 1.41 ± .11 .000* * SU, standing-up; SD sit-down; L, left; R, right. 3.4. Correlation between radiological and clinical variables The thoracic kyphosis Cobb angle (T5–T12) was the only parameter showing a bivariate correlation with selected gait variables (those that presented statistically significant differences between the patient and control groups). The radiological variables that correlated with the thoracic kyphosis angle (T5–T12) were the flexion peak during standing up ( r = .378; p = .028), flexion range during standing up ( r = .376; p = .029), and extension range during standing up ( r = .402; p = .019). 4. Discussion The aim of this study was to evaluate biomechanical differences during gait in patients with severe AIS compared with an age-matched healthy control group, using inertial measurement unit (IMU) technology. Our results confirm that AIS-related spinal deformity leads to significant alterations in gait kinematics and lumbopelvic movement patterns. To our knowledge, this is the first study to objectively assess mobility and gait in patients with severe AIS (> 40°) using IMU-based technology. 4.1. Functional performance Although gait speed in the AIS group was significantly lower than in controls, the absolute values remained within the normal range for healthy adolescents (0.82–1.60 m/s) ( 32 ). Previous studies have reported similar findings, suggesting that reduced gait speed may result from decreased cadence or shorter step length ( 31 , 32 ). In our analysis, cadence and step length did not differ significantly, though AIS patients showed a tendency toward shorter steps. Khorramroo et al. interpreted this reduction as a compensatory strategy aimed at minimizing lateral displacement of the centre of mass to maintain dynamic stability at the expense of gait efficiency ( 9 ). There is ongoing debate regarding whether AIS affects the symmetry of gait parameters such as speed, cadence, and step length between the right and left limbs. While earlier studies found no significant asymmetry ( 15 , 35 , 36 ), more recent works using advanced technology have detected slower step velocity on the limb contralateral to the spinal curve ( 11 , 13 ). In our study, the gait symmetry index exceeded 90% in both groups. This index quantifies the similarity between lower limbs in generating forward acceleration during gait ( 33 ). Although both groups showed high symmetry, AIS patients presented a significantly lower index, indicating a slightly more asymmetric gait. Haber et al. and others complemented their analyses with ground reaction force (GRF) data, finding higher GRF in the leg ipsilateral to the curve convexity, suggesting greater load-bearing and compensatory force generation to maintain balance during gait. The authors interpreted this biomechanical asymmetry as a result of instability ( 11 , 13 ). 4.2. Compensatory strategies AIS patients exhibited significantly higher accelerations in both horizontal and vertical planes during transitions of standing up and sitting down. While no prior studies have assessed these parameters in AIS using the Up and Go test , literature suggests that spinal deformity alters postural control by displacing the center of mass, increasing lateral sway and neuromuscular control demands ( 2 , 15 , 35 ). Mahaudens et al. and other authors reported prolonged muscle activation and greater neuromuscular effort in AIS patients to stabilize balance—particularly in lateral directions—resulting in more abrupt movements ( 2 , 13 , 15 , 30 , 36 ). This compensatory overactivation may explain the greater vertical acceleration observed in our patients during sitting, reflecting a stiffer and less fluid postural control strategy. 4.3. Pelvic motion during gait Multiple studies have shown that AIS is associated with both structural and functional pelvic alterations ( 2 , 14 , 30 ). The pelvis acts as a biomechanical link between the trunk and lower limbs, playing a critical role in force transmission and coordination during gait. Even small changes in pelvic alignment or mobility can affect gait efficiency and energy cost ( 31 ). In our study, radiological spinopelvic parameters in the AIS group were within normal ranges ( 3 – 5 ). In 2004, Roussouly et al. classified lumbopelvic morphologies into four types based on sacral slope (SS). Types 1 and 2 are found in patients with SS < 35°, type 3 in those with SS between 35° and 45°, and type 4 in patients with high SS values (> 45°). The mean SS in our AIS cohort corresponded to a type 3 pattern, which, according to Roussouly’s definition, represents spines with a 50:50 ratio between kyphosis and lordosis lengths—indicative of a well-balanced spinal alignment ( 37 – 39 ). Subsequent studies expanded this classification by introducing an additional subtype, type 3 with anterior pelvic tilt (3AP) ( 40 ). The 3AP subtype is characterized by a sacral slope typical of type 3 (SS 35–45°) but with a reduced pelvic tilt (PT < 8°). On average, the AIS patients in our study could be categorized within the 3AP group according to the updated Roussouly classification. This pattern represents an anteriorly tilted pelvis that achieves global postural balance at the expense of increased compensatory lumbar lordosis ( 40 ). Mac-Thiong et al. described anterior pelvic tilt as more common in children and adolescents, interpreting it as a physiological adaptation to postural immaturity ( 41 ). In our study, AIS patients exhibited a significantly sagittal pelvic -or pelvic tilt- mobility compared with healthy controls, along with a trend toward increased motion in coronal and transverse planes. Syczewska et al. reported similar results, with decreased PT in nearly all patients (22/24) and increased sagittal pelvic mobility, which they interpreted as either altered pelvic control or a compensatory mechanism ( 14 ). In Perry and Jacquelin’s seminal work “Gait Analysis: Normal and Pathological Function,” the increase in the dynamic range of pelvic tilt is described as a compensatory mechanism aimed at maintaining balance and forward progression in the presence of segmental spinal stiffness ( 31 ). Conversely, Mahaudens et al. found that despite altered radiological pelvic morphology, 3D pelvic oscillations during gait did not differ from controls, attributing this apparent stability to prolonged bilateral activation of the spinal erectors and quadratus lumborum muscles ( 2 ). In a later study, the same group reported a 27% reduction in pelvic obliquity motion and shorter step length, suggesting dynamic rigidity due to spinopelvic coactivation ( 36 ). Kramers-de Quervain et al. and Yang et al. observed trunk–pelvis rotational asymmetry during gait, with thoracic convexity-directed trunk torsion and altered transverse-plane torque( 11 , 42 ). These findings align with our observation of an increased pelvic rotation range, possibly reflecting a compensatory pattern counteracting trunk axial torsion. Recent meta-analyses confirm that pelvic obliquity mobilityis often reduced in AIS, accompanied by prolonged electromyographic activity of lumbopelvic stabilizers. However, the extent and direction of these changes depend on curve location, severity, and the analytical method used, which may explain inter-study discrepancies ( 9 , 43 ). Our results support the hypothesis that, in AIS, the pelvis functions not as a rigid segment but as an active modulator of balance and propulsion, adjusting its motion range to spinal stiffness and altered neuromuscular control. 4.4. Lumbopelvic mobility Lumbopelvic mobility plays a fundamental role in everyday functional activities such as transitioning from sitting to standing and trunk flexion-extension movements ( 31 , 32 ). Under physiological conditions, lumbar flexion and anterior pelvic tilt occur in coordination, typically sharing motion at a ratio of about 2:1 between the lumbar spine and pelvis—a synergy known as the lumbopelvic rhythm. This coordination balances load distribution, optimizes paraspinal muscle length-tension, and minimizes stress on intervertebral and sacroiliac joints.( 32 ). In our cohort, AIS patients showed a significant reduction in flexion lumbar peaks and ranges during standing-up (SU) and sitting-down (SD) phases, along with an increased extension range during descent. According to Oatis et al., this pattern reflects an altered lumbopelvic rhythm, with reduced lumbar contribution and increased pelvic participation in extension—a likely compensatory mechanism for spinal rigidity( 32 ). The loss of normal flexion-extension sequencing alters joint moment distribution, requiring sustained activation of spinal erectors and the quadratus lumborum to stabilize the pelvis and maintain the center of mass ( 2 , 32 ). These findings are more consistent with those of Mahaudens et al., who, as we previously mentioned, reported structural rigidity during gait attributed to prolonged bilateral activation of the spinal erectors and quadratus lumborum, which limits anterior trunk flexion. This made us think that the differences between studies are probably due to methodological variations ( 2 ). Similarly, Kim et al. demonstrated in their meta-analysis that AIS patients had a functional stiffness resulting fromprolonged activation of lumbar stabilizers ( 43 ) . Kramers-de Quervain et al. (2004) and Yang et al. (2013) also found trunk–pelvis decoupling during gait and functional tasks, supporting the hypothesis that AIS induces lumbopelvic dissociation, affecting both kinematics and mechanical efficiency ( 11 , 42 ). From a biomechanical perspective, Oatis described that restricted lumbar flexion redistributes forces toward the hips and pelvis, increasing the extensor moment required to overcome body inertia during sit-to-stand transitions. This imbalance heightens the muscular demand on lumbar and gluteal extensors, compromising mechanical efficiency and raising the risk of overload in lower lumbar joints ( 32 ). Thus, the reduced flexion and compensatory extension observed in our patients may represent an adaptive strategy to maintain stability despite spinal rigidity and pelvic asymmetry. 4.5. Limitations This study has several limitations that should be considered when interpreting the results. First, the single-center design and the predominance of female participants may limit the generalizability of the findings. Second, the use of a single inertial sensor placed at the lumbosacral region allowed for precise analysis of trunk and pelvic motion but did not provide segmental kinematic information on the lower limbs. Future studies employing multisegmental IMU configurations could offer a more comprehensive understanding of global movement patterns. Likewise, electromyographic and ground reaction force analyses were not included, preventing a definitive assessment of the muscular contribution to the compensatory patterns observed Finally, heterogeneity in curve type (Lenke 1–5) may have introduced uncontrolled kinematic variability despite demographic matching. 4.6. Conclusion The findings of this study provide a detailed functional perspective on the impact of severe adolescent idiopathic scoliosis on spinopelvic mobility and gait, identifying compensatory patterns previously described mainly qualitatively. The use of inertial sensors enables objective and reproducible quantification of lumbopelvic rhythm alterations and gait asymmetry during daily functional tasks, offering an accessible assessment tool for clinical environments. These results reinforce the value of inertial instrumentation as a complement to traditional radiological evaluation, enhancing preoperative planning and supporting personalized rehabilitation strategies aimed at restoring movement efficiency and preventing postoperative stiffness. Future research should include postoperative longitudinal follow-up and multisegmental IMU configurations to investigate dynamic recovery and neuromuscular control evolution after surgical correction. Declarations Author Contribution The study was designed by P.U., T.B., and J.M.-G. Fieldwork and data collection were carried out by P.U. and M.B. P.U. performed data analysis and wrote the main manuscript text. J.M.-G. and T.B. supervised the study design, data interpretation, and manuscript preparation. J.L.B., P.B., P.R., S.P., and J.M. contributed to patient recruitment and follow-up supervision. All authors reviewed and approved the final version of the manuscript. Data Availability The clinical and biomechanical datasets generated and analyzed during the current study are not publicly available due to patient confidentiality and institutional data protection policies of Hospital Universitari i Politècnic La Fe. However, anonymized data supporting the findings of this study are available from the corresponding author, Dr. Pablo Ulldemolins, upon reasonable request and with permission from the institution. References Kotwicki T, Walczak A, Szulc A. Trunk rotation and hip joint range of rotation in adolescent girls with idiopathic scoliosis: does the “dinner plate” turn asymmetrically ? Scoliosis. 2008 Jan 19;3. Mahaudens P, Thonnard JL, Detrembleur C. Influence of structural pelvic disorders during standing and walking in adolescents with idiopathic scoliosis. Spine Journal. 2005 Jul;5(4):427–33. Walker AP, Dickson RA. School screening and pelvic tilt scoliosis. Lancet. 1984 Jul 21;2(8395):152–4. Menger RP, Sin AH. Adolescent Idiopathic Scoliosis. StatPearls. 2023 Apr 3; Sociedad Española de Columna Vertebral. Patología de la Columna Vertebral - GEER – Marbán Libros. 1st ed. España: Marbán; Mar DE, Kisinde S, Lieberman IH, Haddas R. Representative dynamic ranges of spinal alignment during gait in patients with mild and severe adult spinal deformities. Spine Journal. 2021 Mar 1;21(3):518–27. Qiu XS, Wang ZW, Qiu Y, Wang WJ, Mao SH, Zhu ZZ, et al. Preoperative pelvic axial rotation: A possible predictor for postoperative coronal decompensation in thoracolumbar/lumbar adolescent idiopathic scoliosis. European Spine Journal. 2013 Jun;22(6):1264–72. Kluger D, Major MJ, Fatone S, Gard SA. The effect of trunk flexion on lower-limb kinetics of able-bodied gait. Hum Mov Sci. 2014 Feb;33(1):395–403. Khorramroo F, Mousavi SH, Rajabi R. Effects of spinal deformities on lower limb kinematics during walking: a systematic review and meta-analysis. Sci Rep. 2025 Dec 1;15(1). Syczewska M, Graff K, Kalinowska M, Szczerbik E, Domaniecki J. Influence of the structural deformity of the spine on the gait pathology in scoliotic patients. Gait Posture. 2012 Feb;35(2):209–13. Yang JH, Suh SW, Sung PS, Park WH. Asymmetrical gait in adolescents with idiopathic scoliosis. European Spine Journal. 2013 Nov 1;22(11):2407–13. Şahin F, Urak Ö, Akkaya N. Evaluation of balance in young adults with idiopathic scoliosis. Turk J Phys Med Rehabil. 2019;65(3):236–43. Haber CK, Sacco M. Scoliosis: lower limb asymmetries during the gait cycle. Arch Physiother. 2015 Dec 1;5(1). Syczewska M, Łukaszewska A, Górak B, Graff K. Changes in gait pattern in patients with scoliosis. Vol. 10, Medical Rehabilitation. 2006. Chen PQ, Wang JL, Tsuang YH, Liao TL, Huang PL, Hang YS. The postural stability control and gait pattern of idiopathic scoliosis adolescents. Clinical Biomehanics. 1998;13:52–8. Young-Hoon P, Chang-Hong Y, Kook-Woong S. Accuracy and Consistency of Three-Dimensional Motion Analysis System. Korean Journal of Sport Biomechanics. 2005;15:83. Zecca M, Saito K, Sessa S, Bartolomeo L, Lin Z, Cosentino S, et al. Use of an ultra-miniaturized IMU-based motion capture system for objective evaluation and assessment of walking skills. Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS. 2013;4883–6. Renani MS, Myers CA, Zandie R, Mahoor MH, Davidson BS, Clary CW. Deep learning in gait parameter prediction for oa and tka patients wearing imu sensors. Sensors (Switzerland). 2020 Oct 1;20(19):1–21. Latajka A, Stefańska M, Woźniewski M, Malicka I. Walking Speed and Risk of Falling Patients Operated for Selected Malignant Tumors. Healthcare (Switzerland). 2023 Dec 1;11(23). Jover-Jorge N, González-Rojo P, Amaya-Valero JV, Baixauli-García F, De La Calva-Ceinós C, Angulo-Sánchez M, et al. Comparative analysis of spatiotemporal gait parameters in patients with distal femoral megaprosthesis and healthy subjects using an inertial measurement unit (IMU). Wearable Technologies. 2025 Jun 13;6. Moltó IN, Albiach JP, Amer-Cuenca JJ, Segura-Ortí E, Gabriel W, Martínez-Gramage J. Wearable sensors detect differences between the sexes in lower limb electromyographic activity and pelvis 3D kinematics during running. Sensors (Switzerland). 2020 Nov 2;20(22):1–13. Martínez-Gramage J, Albiach JP, Moltó IN, Amer-Cuenca JJ, Moreno VH, Segura-Ortí E. A random forest machine learning framework to reduce running injuries in young triathletes. Sensors (Switzerland). 2020 Nov 1;20(21):1–12. Teufl W, Miezal M, Taetz B, Frohlichi M, Bleser G. Validity of inertial sensor based 3D joint kinematics of static and dynamic sport and physiotherapy specific movements. PLoS One. 2019 Feb 1;14(2). Al-Amri M, Nicholas K, Button K, Sparkes V, Sheeran L, Davies JL. Inertial measurement units for clinical movement analysis: Reliability and concurrent validity. Sensors (Switzerland). 2018 Mar 1;18(3). Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, et al. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis - PubMed. The Journal of Bone & Joint Surgery. 2001 Oct;83(8):1169–81. G-WALK | Wearable inertial sensor for motion analysis | BTS [Internet]. [cited 2025 Sep 8]. Available from: https://www.btsbioengineering.com/products/g-walk/ Browne W, Nair BKR. The timed up and go test. Vol. 210, Medical Journal of Australia. Australasian Medical Publishing Co. Ltd; 2019. Casano HAM, Ahmed I, Anjum F. Six-Minute Walk Test. Kinesitherapie. 2025 Jul 7;7(68–69):68. Costantini S, Redaelli DF, Fraschini P, Biffi E, Storm FA. On mobility and gait in scoliosis patients: a comparison of conventional and 3D-printed braces during an instrumented timed-up and go test. BMC Musculoskelet Disord. 2025 Dec 1;26(1). Mahaudens P, Detrembleur C, Mousny M, Banse X. Gait in thoracolumbar/lumbar adolescent idiopathic scoliosis: Effect of surgery on gait mechanisms. European Spine Journal. 2010 Jul;19(7):1179–88. Perry Jacquelin, Burnfield Judith. Gait Analysis: Normal and Pathological Function : Perry, Dr. Jacquelin, Burnfield, Dr. Judith: Amazon.es: Libros. 2nd ed. Slack; 2010. Oatis CA. The Mechanics and Pathomechanics of Human Movement Second Edition. Macellari V, Giacomozzi C, Saggini R. Spatial-temporal parameters of gait: reference data and a statistical method for normality assessment. Gait Posture. 1999 Oct 1;10(2):171–81. Bernardini M, Quarto G, Del Sole D, Bernardini E. Influences of postural alterations on the hemodynamic of the gait in patients with saphenous incompetence. A preliminary study - PubMed. Ann Ital Chir. 2019;90:545–50. Byl NN, Gray JM. Complex Balance Reactions in Different Sensory Conditions: Adolescents With and Without Idiopathic Scoliosis. The Journal of Bone and Joint Surgery. Orthopaedic Research Society; 1993. Mahaudens P, Banse X, Mousny M, Detrembleur C. Gait in adolescent idiopathic scoliosis: Kinematics and electromyographic analysis. European Spine Journal. 2009 Apr;18(4):512–21. Roussouly P, Gollogly S, Berthonnaud E, Dimnet J. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976) [Internet]. 2005 Feb 1 [cited 2025 Nov 20];30(3):346–53. Available from: https://journals.lww.com/spinejournal/fulltext/2005/02010/classification_of_the_normal_variation_in_the.16.aspx Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP. Pelvic tilt and truncal inclination: Two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976) [Internet]. 2009 Aug [cited 2025 Nov 20];34(17). Available from: https://journals.lww.com/spinejournal/fulltext/2009/08010/pelvic_tilt_and_truncal_inclination__two_key.28.aspx Pizones J, Hills J, Kelly MP, Alavi F, Nuñez-Pereira S, Smith JS, et al. Alignment Goals in Adult Spinal Deformity Surgery. Global Spine J [Internet]. 2025 Jul 1 [cited 2025 Nov 20];15(3_suppl):108S-122S. Available from: https://pubmed.ncbi.nlm.nih.gov/40632289/ Laouissat F, Sebaaly A, Gehrchen M, Roussouly P. Classification of normal sagittal spine alignment: refounding the Roussouly classification. Eur Spine J [Internet]. 2018 Aug 1 [cited 2025 Nov 20];27(8):2002–11. Available from: https://pubmed.ncbi.nlm.nih.gov/28455623/ Mac-Thiong JM, Labelle H, Roussouly P. Pediatric sagittal alignment. Eur Spine J [Internet]. 2011 Aug 3 [cited 2025 Nov 23];20 Suppl 5(5):586–90. Available from: https://link.springer.com/article/10.1007/s00586-011-1925-0 Kramers-De Quervain IA, Müller R, Stacoff A, Grob D, Stüssi E. Gait analysis in patients with idiopathic scoliosis. European Spine Journal. 2004;13(5):449–56. Kim DS, Park SH, Goh TS, Son SM, Lee JS. A meta-analysis of gait in adolescent idiopathic scoliosis. Journal of Clinical Neuroscience. 2020 Nov 1;81:196–200. Additional Declarations No competing interests reported. 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Technology\",\"fulltext\":[{\"header\":\"1. Introduction\",\"content\":\"\\u003cp\\u003eAdolescent idiopathic scoliosis (AIS) is the most common spinal deformity in adolescents, affecting between 1\\u0026ndash;4% of the population under 18 years of age, with a predominance in females(\\u003cspan additionalcitationids=\\\"CR2\\\" citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e). Currently, no identifiable cause of AIS has been established, although proposed theories include hormonal factors, growth disturbances, muscular imbalance, and genetic components. Only about 0.1% of AIS cases are considered severe, defined as curves greater than 40\\u0026deg; (\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e) .\\u003c/p\\u003e\\u003cp\\u003eIn adults, spinal deformities trigger compensatory spinopelvic mechanisms. The most significant changes include increased pelvic tilt and greater knee flexion, which result in slower gait speed, shorter stride length, and increased joint stress due to activation of compensatory mechanisms(\\u003cspan additionalcitationids=\\\"CR7 CR8\\\" citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eIn adolescents, compensatory mechanisms are less evident. Patients with AIS have been reported to exhibit asymmetric gait patterns, changes in pelvic orientation, restricted pelvic mobility, and less efficient walking. However, studies remain limited and mostly focus on moderate deformities (\\u0026lt;\\u0026thinsp;40\\u0026ordm;) (\\u003cspan additionalcitationids=\\\"CR11 CR12 CR13 CR14\\\" citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e). Moreover, data collection systems commonly used in the literature rely on specialized equipment, making study results difficult to compare and reproduce(\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eAn innovative alternative for motion analysis is the use of inertial measurement units (IMUs). These devices are lightweight, versatile, and cost-effective compared to traditional laboratory systems. They allow objective and accurate recording of movement patterns through simple tests that can be performed directly in healthcare settings, without the need for complex equipment. Due to these advantages, IMUs have become a widely used tool in gait analysis and mobility assessment, particularly in the fields of orthopedic surgery and sports medicine (\\u003cspan additionalcitationids=\\\"CR18 CR19 CR20 CR21 CR22 CR23\\\" citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003eThe aim of our study is to compare whether patients with severe AIS present changes in pelvic orientation, spinal mobility restriction, and asymmetric gait compared to a healthy age-matched control group using IMUs. Furthermore, we evaluate whether radiological variables associated with the deformity can explain differences in gait patterns.\\u003c/p\\u003e\"},{\"header\":\"2. Methodology\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.1 Study population\\u003c/h2\\u003e\\u003cp\\u003eA gait analysis study was conducted on 35 patients with AIS prior to surgery and compared with a control group of 34 healthy adolescents.\\u003c/p\\u003e\\u003cp\\u003eAll participants in the patient group were diagnosed with adolescent idiopathic scoliosis, presenting a primary thoracolumbar/lumbar curve according to the Lenke classification (\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e) with a severe Cobb angle (\\u0026gt;\\u0026thinsp;40\\u0026deg;). Patients with congenital, early-onset, syndromic, or neuromuscular scoliosis, as well as those with cardiopulmonary disorders or conditions that could alter gait patterns, were excluded.\\u003c/p\\u003e\\u003cp\\u003eAll patients were treated at our center by the Spine Unit of the Hospital Universitari i Polit\\u0026egrave;cnic La Fe, Valencia. Each patient had worn a Boston-type brace for more than one year, in accordance with standard treatment protocols for adolescent idiopathic scoliosis (\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThe control group consisted of 34 healthy adolescents with a similar gender distribution and age range, recruited from public schools in our region. To be included in the control group, participants had to be healthy adolescents aged 13\\u0026ndash;25 years with no history of medical conditions.\\u003c/p\\u003e\\u003cp\\u003e The study protocol was approved by the Human Research Ethics Committee of Hospital La Fe (2024-0818-1). All procedures were conducted in accordance with the principles of the Declaration of Helsinki of the World Medical Association, and written informed consent was obtained from all participants prior to inclusion.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.2. Clinical and Radiological Assessment\\u003c/h2\\u003e\\u003cp\\u003eEach patient was evaluated three months before surgery. At each assessment, body weight, height, and body mass index were recorded. Shoulder, scapular, waist, and hip asymmetry were evaluated, and the Adams forward bend test was performed to assess rib hump prominence. Overall spinal alignment and posture were also examined. A systematic neurological assessment was performed at each visit, following the most recent AIS clinical guidelines (\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eEach patient underwent a full standing anteroposterior spinal radiograph before surgery. Curves were classified according to the Lenke classification (\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e). Radiographic measurements included coronal and sagittal Cobb angles, coronal and sagittal balance, clavicular asymmetry, pelvic obliquity, pelvic tilt (PT), pelvic incidence (PI), and sacral slope (SS). Skeletal maturity was assessed using the Risser scale, and flexibility of the minor curve was evaluated through a side-bending test. Curves were considered flexible if they decreased by at least 50% or presented a Cobb angle\\u0026thinsp;\\u0026lt;\\u0026thinsp;25\\u0026deg; during bending. All assessments followed the latest AIS and spine surgery guidelines (\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.3. Gait Analysis\\u003c/h2\\u003e\\u003cp\\u003eGait analysis was performed using a portable, noninvasive BTS G-Sensor device (BTS Bioengineering, Garbagnate Milanese, Italy) (weight\\u0026thinsp;=\\u0026thinsp;28 g; dimensions\\u0026thinsp;=\\u0026thinsp;70.5 mm L \\u0026times; 41 mm W \\u0026times; 19.2 mm H).\\u003c/p\\u003e\\u003cp\\u003eThe device includes a triaxial accelerometer with multiple sensitivities (2, 4, 6, 8, and 16 g) and sampling frequencies from 4 Hz to 1000 Hz, a triaxial gyroscope (250, 500, 1000, or 2000 \\u0026deg;/s) with sampling frequencies between 4 Hz and 8000 Hz, and a 13-bit triaxial magnetometer (1200 \\u0026micro;T) with a frequency above 100 Hz (\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003eThe sensor was positioned near the body\\u0026rsquo;s center of mass at the L5\\u0026ndash;S1 level, using double-sided medical-grade adhesive tape and an elastic belt for fixation. The X-axis of the sensor pointed in the anteroposterior (AP) direction, the Y-axis in the mediolateral (ML) direction, and the Z-axis vertically (VT) relative to the ground (\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003eData were processed using BTS G-Studio\\u0026reg; software (v2.8.16.1), which automatically segments gait cycles and extracts parameters based on validated protocols (\\u003cem\\u003eUp and Go, Walk and 6-minute\\u003c/em\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThe \\u003cem\\u003eUp and Go test\\u003c/em\\u003e assessed functional mobility by measuring the total time required for the subject to stand up from a chair, walk three meters, return, and sit down again; this test was performed twice per participant (\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThe \\u003cem\\u003eWalk test\\u003c/em\\u003e consisted of walking seven meters back and forth, providing quantitative gait data such as cadence, walking speed, stride length, limb symmetry index, propulsion, and pelvic movements (\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eIn the \\u003cem\\u003e6-minute test\\u003c/em\\u003e participants walked continuously for six minutes along a 30-meter path back and forth, measuring total distance covered and walking speed (\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThe \\u003cem\\u003eUp and Go test\\u003c/em\\u003e has been used in previous studies to assess mobility and gait in AIS patients AIS (\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e). The \\u003cem\\u003eWalk\\u003c/em\\u003e and \\u003cem\\u003e6-Minute tests\\u003c/em\\u003e are unobstructed gait protocols similar to those applied in earlier research ( (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eA second-order Butterworth filter with a cutoff frequency of 10 Hz was applied to minimize high-frequency noise. Gait cycles were segmented using vertical acceleration peaks to identify heel strikes, based on adaptive thresholding methods validated in previous IMU-based gait studies. The software calculated step-by-step metrics for each gait cycle. For each participant, the reported value of each parameter corresponds to the mean of all valid steps during straight-line walking.\\u003c/p\\u003e\\u003cp\\u003eThe gait analysis parameters collected in each test are summarized in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eVariables of each test and their definitions.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"2\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eVariables\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDefinition\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTest Up and Go\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTotal (s)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eOverall time required to complete the Timed Up and Go test, including sit-to-stand, gait, turning, return, and stand-to-sit phases, reflecting global mobility and functional performance.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSU_SD (s)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eTime interval needed to complete sit-to-stand and stand-to-sit transitions, indicating efficiency of postural change and control of sagittal plane motion(\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSU_SD (m/s\\u003csup\\u003e2\\u003c/sup\\u003e)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003ePeak linear acceleration of the trunk or center of mass during sit-to-stand and stand-to-sit, representing the dynamic demand for muscle power and balance during transitional movements(\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSpin velocity (\\u0026ordm;/s)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eAngular speed of trunk rotation during the turning phase of the Timed Up and Go test, quantifying dynamic stability and coordination of axial motion (\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSU_SD (\\u0026ordm;max)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMaximum joint angles reached during sit-to-stand and stand-to-sit transitions, reflecting hip mobility and muscle control demands in the sagittal plane(\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSU_SD range (\\u0026ordm;)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eTotal angular excursion of the hip during sit-to-stand and stand-to-sit transitions, determined by the interplay between pelvic motion, thigh displacement, and postural requirements(\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eTest Walk\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eStep-cadence (step/min)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eNumber of steps taken per minute, reflecting the temporal rhythm of gait and commonly used as an indicator of walking speed and efficiency (\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eL_R Step-length (m)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eInterval between initial contact of each foot, influenced by pelvic rotation during swing, which contributes to overall stride length (\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSimmetry index (%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eQuantifies the symmetry of forward acceleration between limbs, calculated using normalized bilateral differences (\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePropulsion\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMeasures the subject\\u0026rsquo;s ability to propel the center of mass forward during the single support stance phase. Lower values may indicate impaired strength or propulsion asymmetry (\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e3D kinematics of the pelvis (\\u0026ordm;)(%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eIncludes the range (\\u0026ordm;) and symmetry index (%) of tilt, obliquity and rotation, derived from angular velocity data, allowing assessment of trunk control and limb coordination (\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eTest 6-minutes\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eDistance (m)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eTotal distance covered while walking continuously for six minutes at a self-selected pace, reflecting submaximal functional exercise capacity, endurance, and efficiency of gait performance (\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSpeed (m/s)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eEstimated using anthropometrically scaled stride length and step frequency, avoiding double integration of acceleration and minimizing drift using sensor fusion algorithms integrated into the IMU (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003ctfoot\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"2\\\"\\u003e\\u003cb\\u003e*\\u003c/b\\u003e SU, standing-up; SD sit-down; L, left; R, right.\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tfoot\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.4. Protocol\\u003c/h2\\u003e\\u003cp\\u003eGait analysis was performed on patients three months prior to surgical intervention. The assessment took place along a 30-meter corridor specifically designated for this purpose, both at the hospital center (for the AIS group) and at educational facilities (for the control group), ensuring identical space, surface, and measurement conditions in both settings.\\u003c/p\\u003e\\u003cp\\u003eParticipants were instructed to keep their gaze forward, avoid head rotations, and swing their arms naturally while walking. Before data collection began, each subject completed a 5-minute familiarization walk to ensure a spontaneous and stable gait pattern.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.5. Statistical Analysis\\u003c/h2\\u003e\\u003cp\\u003eStatistical analysis was performed using IBM SPSS Statistics 25.0 (IBM, Chicago, IL, USA). Measurement results were expressed as mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation for each group. Normality was tested using the Kolmogorov\\u0026ndash;Smirnov test. For normally distributed data, independent-sample \\u003cem\\u003et\\u003c/em\\u003e-tests were used to analyze differences in symmetry and regularity variables between the control group and the preoperative AIS group. For non-normally distributed variables, the nonparametric Mann\\u0026ndash;Whitney U test was used. Categorical variables were compared using the Chi-square test.\\u003c/p\\u003e\\u003cp\\u003eTo assess bivariate correlations between gait parameters and radiological variables, Pearson\\u0026rsquo;s correlation test was performed between the radiological parameters and the gait variables that showed statistically significant differences between AIS patients and controls. A \\u003cem\\u003ep\\u003c/em\\u003e-value\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 was considered statistically significant.\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"3. Results\",\"content\":\"\\u003cdiv id=\\\"Sec9\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e3.1. Population Characteristics\\u003c/h2\\u003e\\u003cp\\u003eThe study included a total of 35 AIS patients and 34 healthy controls. Demographic characteristics, including age, weight, and sex distribution, were similar between the AIS and control groups (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05) (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eMean value and standard deviation of subject characteristics\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"4\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eParameters\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eAIS (n\\u0026thinsp;=\\u0026thinsp;33)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eHealthy (n\\u0026thinsp;=\\u0026thinsp;34)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003ep-value\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFemale rate (%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e90.9\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e88.2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.517\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAge (year)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e15.93\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.47\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e17.38\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.77\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.117\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eWeight (kg)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e54.80\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.88\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e56.38\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.62\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.531\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eHeight (cm)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e161.24\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.24\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e166.82\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.4\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eBMI (kg/m2)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e21.01\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.66\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e20.23\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.348\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c4\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eNotes.\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eAIS, adolescent idiopathic soliosis; BMI, body max index.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec10\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e3.2. Radiographic Characteristics of the AIS Group\\u003c/h2\\u003e\\u003cp\\u003eA total of 45.7% of patients with AIS were classified as Lenke type 1, followed by 31.4% classified as Lenke type 3 (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e). Most curves (94.2%) were right-sided and 21 (60%) demonstrated flexibility on radiographic bending tests. The mean Risser grade was 3.84\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.03. The mean Cobb angle of the thoracic curve was 70.54\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;16.06\\u0026deg;, and that of the lumbar curve was 49.57\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;21.68\\u0026deg;. A detailed description of the group\\u0026rsquo;s radiological measurements is presented in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eDistribution of patients according to Lenke\\u0026rsquo;s types\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"3\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLenke\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e%\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLenke 1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e16\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e45.7\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLenke 2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e5.7\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLenke 3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e11\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e31.4\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLenke 4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e2.9\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLenke 5\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e8.6\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLenke 6\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e5.7\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eMean value and standard deviation of radiological variables of AIS patients\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"3\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eVariables\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eAIS patients\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eRange of normal values (\\u003cspan additionalcitationids=\\\"CR4\\\" citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e)\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eThoracolumbar curve (\\u0026ordm;)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e70.54\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;16.06\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLumbar curve (\\u0026ordm;)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e49.57\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;21.68\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCoronal alignment (cm)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2.25\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.71\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;2\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePelvic obliquity (\\u0026ordm;)\\u0026ordm;\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.91\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.26\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;5\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eShoulder imbalance\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.61\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.33\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCervical lordosis (\\u0026ordm;)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e14.97\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.49\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e20\\u0026ndash;40\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eThoracic kyphosis (\\u0026ordm;)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e27.02\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.62\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e20\\u0026ndash;50\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLumbar lordosis (\\u0026ordm;)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e49.64\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.41\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u0026ndash;60\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSagital vertical axis (mm)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3.39\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.36\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;5\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eT10-L2 transition (\\u0026ordm;)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e13.93\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.02\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;10\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSS (\\u0026ordm;)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e37.82\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.20\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e30\\u0026ndash;50\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePI (\\u0026ordm;)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e48.05\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.16\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u0026ndash;60\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePT (\\u0026ordm;)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e9.61\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.09\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e7\\u0026ndash;15\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003ctfoot\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"3\\\"\\u003e* SS, sacral slope; PI, pelvic incidence; PT pelvic tilt.\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tfoot\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e3.3. Gait differences between AIS patients and controls\\u003c/h2\\u003e\\u003cdiv id=\\\"Sec12\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003e3.3.1. Up and Go test\\u003c/h2\\u003e\\u003cp\\u003eAlthough no significant differences were found in the total duration of the test, distinct movement strategies were observed between groups (Table\\u0026nbsp;5).\\u003c/p\\u003e\\u003cp\\u003eAIS patients showed significantly higher accelerations during functional transitions of standing up and sitting down. Specifically, they exhibited greater horizontal acceleration when standing up (\\u0026plusmn;\\u0026thinsp;1.14 m/s\\u0026sup2;) and greater vertical acceleration when sitting down (\\u0026plusmn;\\u0026thinsp;1.62 m/s\\u0026sup2;) compared with the control group (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05).\\u003c/p\\u003e\\u003cp\\u003eAdditionally, AIS patients demonstrated significantly reduced trunk flexion and extension peaks and ranges compared with healthy controls (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05).\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec13\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003e3.3.2. Walk test\\u003c/h2\\u003e\\u003cp\\u003eNo significant differences were found between groups in cadence, step length, or propulsion (Table\\u0026nbsp;5). However, the control group showed a significantly more symmetrical gait pattern and a smaller range of pelvic tilt (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05)\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec14\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003e3.3.3. 6-minute test\\u003c/h2\\u003e\\u003cp\\u003eThe control group covered a greater distance and walked at a higher speed than the AIS group, with statistically significant differences (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"No\\\" id=\\\"Taba\\\" border=\\\"1\\\"\\u003e\\u003ccolgroup cols=\\\"5\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c4\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eTable\\u0026nbsp;5. Gait parameters between idiopathic scoliosis patients, healthy subject, and post-surgery patients\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eVariables\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eAIS\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eHealthy\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003ep-value\\u003c/b\\u003e\\u003csup\\u003e\\u003cb\\u003e1\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eUp and Go test\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTotal (s)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e9.63\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.35\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e10.02\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.27\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.401\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSU (s)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.17\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.32\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.19\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.833\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSD (s)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e1.24\\u003c/b\\u003e\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;\\u003cb\\u003e0.39\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e1.42\\u003c/b\\u003e\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;\\u003cb\\u003e0.30\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e.004*\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSU horizontal acc.(m/s\\u003csup\\u003e2\\u003c/sup\\u003e)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e4.63\\u003c/b\\u003e\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;\\u003cb\\u003e1.98\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e3.49\\u003c/b\\u003e\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;\\u003cb\\u003e1.05\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e.004*\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSD horizontal acc.(m/s\\u003csup\\u003e2\\u003c/sup\\u003e)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e5.12\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.85\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4.36\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.74\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.088\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSU lateral acc. (m/s\\u003csup\\u003e2\\u003c/sup\\u003e)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3,39\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.57\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e2.88\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.93\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.115\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSD lateral. acc. (m/s\\u003csup\\u003e2\\u003c/sup\\u003e)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e5.17\\u003c/b\\u003e\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;\\u003cb\\u003e1.58\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e4.24\\u003c/b\\u003e\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;\\u003cb\\u003e1.50\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e.016*\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSU vertical. acc. (m/s\\u003csup\\u003e2\\u003c/sup\\u003e)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e5.98\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.82\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e5.57\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.74\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.351\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSD vertical. acc. (m/s\\u003csup\\u003e2\\u003c/sup\\u003e)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e7.62\\u003c/b\\u003e\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;\\u003cb\\u003e2.61\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e6.00\\u003c/b\\u003e\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;\\u003cb\\u003e1.84\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e.005*\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSpin velocity (\\u0026ordm;/s)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e213.72\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;36.49\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e215.27\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;33.40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.640\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSU flexion peak (\\u0026ordm;)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e31.08\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8,67\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e33.68\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.44\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.246\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSU flexion range (\\u0026ordm;)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e31.00\\u003c/b\\u003e\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;\\u003cb\\u003e8.67\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e33.32\\u003c/b\\u003e\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;\\u003cb\\u003e9.82\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e.038*\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSD flexion peak (\\u0026ordm;)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e29.86\\u003c/b\\u003e\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;\\u003cb\\u003e9.12\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e34.87\\u003c/b\\u003e\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;\\u003cb\\u003e10.88\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e.046*\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSD flexion range (\\u0026ordm;)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e16.43\\u003c/b\\u003e\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;\\u003cb\\u003e10.57\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e14.07\\u003c/b\\u003e\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;\\u003cb\\u003e11.70\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e.006*\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSU extension peak (\\u0026ordm;)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e19.73\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.94\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e24.46\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.82\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.309\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSU extension range (\\u0026ordm;)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e11.51\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.42\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e9.12\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.57\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.200\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSD extension peak (\\u0026ordm;)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e7.18\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.05\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e3.86\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.390\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSD extension range (\\u0026ordm;)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e26.08\\u003c/b\\u003e\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;\\u003cb\\u003e9.30\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e34.72\\u003c/b\\u003e\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;\\u003cb\\u003e10.32\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e.001*\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eWalk test\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eStep-cadence (step/min)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e115.94\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.35\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e113.81\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.60\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.336\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eL Step-length (m)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.19\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.22\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.26\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.16\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.116\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eR Step-length (m)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.18\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.21\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.26\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.16\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.118\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSimmetry index (%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e92.51\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.01\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e95.60\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.79\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e.003*\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePropulsion\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e9.58\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.27\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e9.09\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.06\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.359\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePelvic tilt simmetry (%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e65.97\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;47.47\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e65.95\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;22.50\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.998\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePelvic tilt range (\\u0026ordm;)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e6.33\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.74\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e4.50\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.52\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e.006*\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePelvic obliquity simmetry (%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e94.31\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.80\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e97.39\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.33\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.205\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePelvic obliquity range (\\u0026ordm;)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e9.27\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.19\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e8.79\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.74\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.569\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePelvic rotation simmetry (%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e90.18\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e91.78\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;25.36\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.660\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePelvic rotation range (\\u0026ordm;)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e12.57\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.80\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e11.23\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.37\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.289\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c5\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e6-minutes test\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eDistance (m)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e421.16\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;65.12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e463.45\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;35.66\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e.002*\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSpeed (m/s)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.31\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;.01\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.41\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;.11\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e.000*\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c4\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e*\\u003c/b\\u003e SU, standing-up; SD sit-down; L, left; R, right.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e3.4. Correlation between radiological and clinical variables\\u003c/h2\\u003e\\u003cp\\u003eThe thoracic kyphosis Cobb angle (T5\\u0026ndash;T12) was the only parameter showing a bivariate correlation with selected gait variables (those that presented statistically significant differences between the patient and control groups). The radiological variables that correlated with the thoracic kyphosis angle (T5\\u0026ndash;T12) were the flexion peak during standing up (\\u003cem\\u003er\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;.378; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;.028), flexion range during standing up (\\u003cem\\u003er\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;.376; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;.029), and extension range during standing up (\\u003cem\\u003er\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;.402; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;.019).\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"4. Discussion\",\"content\":\"\\u003cp\\u003eThe aim of this study was to evaluate biomechanical differences during gait in patients with severe AIS compared with an age-matched healthy control group, using inertial measurement unit (IMU) technology. Our results confirm that AIS-related spinal deformity leads to significant alterations in gait kinematics and lumbopelvic movement patterns. To our knowledge, this is the first study to objectively assess mobility and gait in patients with severe AIS (\\u0026gt;\\u0026thinsp;40\\u0026deg;) using IMU-based technology.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec17\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e4.1. Functional performance\\u003c/h2\\u003e\\u003cp\\u003eAlthough gait speed in the AIS group was significantly lower than in controls, the absolute values remained within the normal range for healthy adolescents (0.82\\u0026ndash;1.60 m/s) (\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e). Previous studies have reported similar findings, suggesting that reduced gait speed may result from decreased cadence or shorter step length (\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e). In our analysis, cadence and step length did not differ significantly, though AIS patients showed a tendency toward shorter steps.\\u003c/p\\u003e\\u003cp\\u003eKhorramroo et al. interpreted this reduction as a compensatory strategy aimed at minimizing lateral displacement of the centre of mass to maintain dynamic stability at the expense of gait efficiency (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThere is ongoing debate regarding whether AIS affects the symmetry of gait parameters such as speed, cadence, and step length between the right and left limbs. While earlier studies found no significant asymmetry (\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e), more recent works using advanced technology have detected slower step velocity on the limb contralateral to the spinal curve (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eIn our study, the gait symmetry index exceeded 90% in both groups. This index quantifies the similarity between lower limbs in generating forward acceleration during gait (\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e). Although both groups showed high symmetry, AIS patients presented a significantly lower index, indicating a slightly more asymmetric gait.\\u003c/p\\u003e\\u003cp\\u003eHaber et al. and others complemented their analyses with ground reaction force (GRF) data, finding higher GRF in the leg ipsilateral to the curve convexity, suggesting greater load-bearing and compensatory force generation to maintain balance during gait. The authors interpreted this biomechanical asymmetry as a result of instability (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec18\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e4.2. Compensatory strategies\\u003c/h2\\u003e\\u003cp\\u003eAIS patients exhibited significantly higher accelerations in both horizontal and vertical planes during transitions of standing up and sitting down. While no prior studies have assessed these parameters in AIS using the \\u003cem\\u003eUp and Go test\\u003c/em\\u003e, literature suggests that spinal deformity alters postural control by displacing the center of mass, increasing lateral sway and neuromuscular control demands (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eMahaudens et al. and other authors reported prolonged muscle activation and greater neuromuscular effort in AIS patients to stabilize balance\\u0026mdash;particularly in lateral directions\\u0026mdash;resulting in more abrupt movements (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e). This compensatory overactivation may explain the greater vertical acceleration observed in our patients during sitting, reflecting a stiffer and less fluid postural control strategy.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec19\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e4.3. Pelvic motion during gait\\u003c/h2\\u003e\\u003cp\\u003eMultiple studies have shown that AIS is associated with both structural and functional pelvic alterations (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e). The pelvis acts as a biomechanical link between the trunk and lower limbs, playing a critical role in force transmission and coordination during gait. Even small changes in pelvic alignment or mobility can affect gait efficiency and energy cost (\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eIn our study, radiological spinopelvic parameters in the AIS group were within normal ranges (\\u003cspan additionalcitationids=\\\"CR4\\\" citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e). In 2004, Roussouly et al. classified lumbopelvic morphologies into four types based on sacral slope (SS). Types 1 and 2 are found in patients with SS\\u0026thinsp;\\u0026lt;\\u0026thinsp;35\\u0026deg;, type 3 in those with SS between 35\\u0026deg; and 45\\u0026deg;, and type 4 in patients with high SS values (\\u0026gt;\\u0026thinsp;45\\u0026deg;). The mean SS in our AIS cohort corresponded to a type 3 pattern, which, according to Roussouly\\u0026rsquo;s definition, represents spines with a 50:50 ratio between kyphosis and lordosis lengths\\u0026mdash;indicative of a well-balanced spinal alignment (\\u003cspan additionalcitationids=\\\"CR38\\\" citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eSubsequent studies expanded this classification by introducing an additional subtype, type 3 with anterior pelvic tilt (3AP) (\\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e). The 3AP subtype is characterized by a sacral slope typical of type 3 (SS 35\\u0026ndash;45\\u0026deg;) but with a reduced pelvic tilt (PT\\u0026thinsp;\\u0026lt;\\u0026thinsp;8\\u0026deg;). On average, the AIS patients in our study could be categorized within the 3AP group according to the updated Roussouly classification. This pattern represents an anteriorly tilted pelvis that achieves global postural balance at the expense of increased compensatory lumbar lordosis (\\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eMac-Thiong et al. described anterior pelvic tilt as more common in children and adolescents, interpreting it as a physiological adaptation to postural immaturity (\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e). In our study, AIS patients exhibited a significantly sagittal pelvic -or pelvic tilt- mobility compared with healthy controls, along with a trend toward increased motion in coronal and transverse planes.\\u003c/p\\u003e\\u003cp\\u003eSyczewska et al. reported similar results, with decreased PT in nearly all patients (22/24) and increased sagittal pelvic mobility, which they interpreted as either altered pelvic control or a compensatory mechanism (\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e). In Perry and Jacquelin\\u0026rsquo;s seminal work \\u003cem\\u003e\\u0026ldquo;Gait Analysis: Normal and Pathological Function,\\u0026rdquo;\\u003c/em\\u003e the increase in the dynamic range of pelvic tilt is described as a compensatory mechanism aimed at maintaining balance and forward progression in the presence of segmental spinal stiffness (\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eConversely, Mahaudens et al. found that despite altered radiological pelvic morphology, 3D pelvic oscillations during gait did not differ from controls, attributing this apparent stability to prolonged bilateral activation of the spinal erectors and quadratus lumborum muscles (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e). In a later study, the same group reported a 27% reduction in pelvic obliquity motion and shorter step length, suggesting dynamic rigidity due to spinopelvic coactivation (\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eKramers-de Quervain et al. and Yang et al. observed trunk\\u0026ndash;pelvis rotational asymmetry during gait, with thoracic convexity-directed trunk torsion and altered transverse-plane torque(\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e). These findings align with our observation of an increased pelvic rotation range, possibly reflecting a compensatory pattern counteracting trunk axial torsion.\\u003c/p\\u003e\\u003cp\\u003eRecent meta-analyses confirm that pelvic obliquity mobilityis often reduced in AIS, accompanied by prolonged electromyographic activity of lumbopelvic stabilizers. However, the extent and direction of these changes depend on curve location, severity, and the analytical method used, which may explain inter-study discrepancies (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eOur results support the hypothesis that, in AIS, the pelvis functions not as a rigid segment but as an active modulator of balance and propulsion, adjusting its motion range to spinal stiffness and altered neuromuscular control.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec20\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e4.4. Lumbopelvic mobility\\u003c/h2\\u003e\\u003cp\\u003eLumbopelvic mobility plays a fundamental role in everyday functional activities such as transitioning from sitting to standing and trunk flexion-extension movements (\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e). Under physiological conditions, lumbar flexion and anterior pelvic tilt occur in coordination, typically sharing motion at a ratio of about 2:1 between the lumbar spine and pelvis\\u0026mdash;a synergy known as the \\u003cem\\u003elumbopelvic rhythm.\\u003c/em\\u003e This coordination balances load distribution, optimizes paraspinal muscle length-tension, and minimizes stress on intervertebral and sacroiliac joints.(\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eIn our cohort, AIS patients showed a significant reduction in flexion lumbar peaks and ranges during standing-up (SU) and sitting-down (SD) phases, along with an increased extension range during descent. According to Oatis et al., this pattern reflects an altered lumbopelvic rhythm, with reduced lumbar contribution and increased pelvic participation in extension\\u0026mdash;a likely compensatory mechanism for spinal rigidity(\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThe loss of normal flexion-extension sequencing alters joint moment distribution, requiring sustained activation of spinal erectors and the quadratus lumborum to stabilize the pelvis and maintain the center of mass (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e). These findings are more consistent with those of Mahaudens et al., who, as we previously mentioned, reported structural rigidity during gait attributed to prolonged bilateral activation of the spinal erectors and quadratus lumborum, which limits anterior trunk flexion. This made us think that the differences between studies are probably due to methodological variations (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e). Similarly, Kim et al. demonstrated in their meta-analysis that AIS patients had a functional stiffness resulting fromprolonged activation of lumbar stabilizers (\\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e) .\\u003c/p\\u003e\\u003cp\\u003eKramers-de Quervain et al. (2004) and Yang et al. (2013) also found trunk\\u0026ndash;pelvis decoupling during gait and functional tasks, supporting the hypothesis that AIS induces lumbopelvic dissociation, affecting both kinematics and mechanical efficiency (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eFrom a biomechanical perspective, Oatis described that restricted lumbar flexion redistributes forces toward the hips and pelvis, increasing the extensor moment required to overcome body inertia during sit-to-stand transitions. This imbalance heightens the muscular demand on lumbar and gluteal extensors, compromising mechanical efficiency and raising the risk of overload in lower lumbar joints (\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e). Thus, the reduced flexion and compensatory extension observed in our patients may represent an adaptive strategy to maintain stability despite spinal rigidity and pelvic asymmetry.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec21\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e4.5. Limitations\\u003c/h2\\u003e\\u003cp\\u003eThis study has several limitations that should be considered when interpreting the results. First, the single-center design and the predominance of female participants may limit the generalizability of the findings.\\u003c/p\\u003e\\u003cp\\u003eSecond, the use of a single inertial sensor placed at the lumbosacral region allowed for precise analysis of trunk and pelvic motion but did not provide segmental kinematic information on the lower limbs. Future studies employing multisegmental IMU configurations could offer a more comprehensive understanding of global movement patterns. Likewise, electromyographic and ground reaction force analyses were not included, preventing a definitive assessment of the muscular contribution to the compensatory patterns observed\\u003c/p\\u003e\\u003cp\\u003eFinally, heterogeneity in curve type (Lenke 1\\u0026ndash;5) may have introduced uncontrolled kinematic variability despite demographic matching.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec22\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e4.6. Conclusion\\u003c/h2\\u003e\\u003cp\\u003eThe findings of this study provide a detailed functional perspective on the impact of severe adolescent idiopathic scoliosis on spinopelvic mobility and gait, identifying compensatory patterns previously described mainly qualitatively.\\u003c/p\\u003e\\u003cp\\u003eThe use of inertial sensors enables objective and reproducible quantification of lumbopelvic rhythm alterations and gait asymmetry during daily functional tasks, offering an accessible assessment tool for clinical environments. These results reinforce the value of inertial instrumentation as a complement to traditional radiological evaluation, enhancing preoperative planning and supporting personalized rehabilitation strategies aimed at restoring movement efficiency and preventing postoperative stiffness.\\u003c/p\\u003e\\u003cp\\u003eFuture research should include postoperative longitudinal follow-up and multisegmental IMU configurations to investigate dynamic recovery and neuromuscular control evolution after surgical correction.\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eThe study was designed by P.U., T.B., and J.M.-G. Fieldwork and data collection were carried out by P.U. and M.B. P.U. performed data analysis and wrote the main manuscript text. J.M.-G. and T.B. supervised the study design, data interpretation, and manuscript preparation. J.L.B., P.B., P.R., S.P., and J.M. contributed to patient recruitment and follow-up supervision. All authors reviewed and approved the final version of the manuscript.\\u003c/p\\u003e\\u003ch2\\u003eData Availability\\u003c/h2\\u003e\\u003cp\\u003eThe clinical and biomechanical datasets generated and analyzed during the current study are not publicly available due to patient confidentiality and institutional data protection policies of Hospital Universitari i Polit\\u0026egrave;cnic La Fe. However, anonymized data supporting the findings of this study are available from the corresponding author, Dr. Pablo Ulldemolins, upon reasonable request and with permission from the institution.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n \\u003cli\\u003eKotwicki T, Walczak A, Szulc A. Trunk rotation and hip joint range of rotation in adolescent girls with idiopathic scoliosis: does the \\u0026ldquo;dinner plate\\u0026rdquo; turn asymmetrically ? Scoliosis. 2008 Jan 19;3.\\u003c/li\\u003e\\n \\u003cli\\u003eMahaudens P, Thonnard JL, Detrembleur C. Influence of structural pelvic disorders during standing and walking in adolescents with idiopathic scoliosis. Spine Journal. 2005 Jul;5(4):427\\u0026ndash;33.\\u003c/li\\u003e\\n \\u003cli\\u003eWalker AP, Dickson RA. School screening and pelvic tilt scoliosis. Lancet. 1984 Jul 21;2(8395):152\\u0026ndash;4.\\u003c/li\\u003e\\n \\u003cli\\u003eMenger RP, Sin AH. Adolescent Idiopathic Scoliosis. StatPearls. 2023 Apr 3;\\u003c/li\\u003e\\n \\u003cli\\u003eSociedad Espa\\u0026ntilde;ola de Columna Vertebral. Patolog\\u0026iacute;a de la Columna Vertebral - GEER \\u0026ndash; Marb\\u0026aacute;n Libros. 1st ed. Espa\\u0026ntilde;a: Marb\\u0026aacute;n;\\u003c/li\\u003e\\n \\u003cli\\u003eMar DE, Kisinde S, Lieberman IH, Haddas R. Representative dynamic ranges of spinal alignment during gait in patients with mild and severe adult spinal deformities. Spine Journal. 2021 Mar 1;21(3):518\\u0026ndash;27.\\u003c/li\\u003e\\n \\u003cli\\u003eQiu XS, Wang ZW, Qiu Y, Wang WJ, Mao SH, Zhu ZZ, et al. Preoperative pelvic axial rotation: A possible predictor for postoperative coronal decompensation in thoracolumbar/lumbar adolescent idiopathic scoliosis. European Spine Journal. 2013 Jun;22(6):1264\\u0026ndash;72.\\u003c/li\\u003e\\n \\u003cli\\u003eKluger D, Major MJ, Fatone S, Gard SA. The effect of trunk flexion on lower-limb kinetics of able-bodied gait. Hum Mov Sci. 2014 Feb;33(1):395\\u0026ndash;403.\\u003c/li\\u003e\\n \\u003cli\\u003eKhorramroo F, Mousavi SH, Rajabi R. Effects of spinal deformities on lower limb kinematics during walking: a systematic review and meta-analysis. Sci Rep. 2025 Dec 1;15(1).\\u003c/li\\u003e\\n \\u003cli\\u003eSyczewska M, Graff K, Kalinowska M, Szczerbik E, Domaniecki J. Influence of the structural deformity of the spine on the gait pathology in scoliotic patients. Gait Posture. 2012 Feb;35(2):209\\u0026ndash;13.\\u003c/li\\u003e\\n \\u003cli\\u003eYang JH, Suh SW, Sung PS, Park WH. Asymmetrical gait in adolescents with idiopathic scoliosis. European Spine Journal. 2013 Nov 1;22(11):2407\\u0026ndash;13.\\u003c/li\\u003e\\n \\u003cli\\u003eŞahin F, Urak \\u0026Ouml;, Akkaya N. Evaluation of balance in young adults with idiopathic scoliosis. Turk J Phys Med Rehabil. 2019;65(3):236\\u0026ndash;43.\\u003c/li\\u003e\\n \\u003cli\\u003eHaber CK, Sacco M. Scoliosis: lower limb asymmetries during the gait cycle. Arch Physiother. 2015 Dec 1;5(1).\\u003c/li\\u003e\\n \\u003cli\\u003eSyczewska M, Łukaszewska A, G\\u0026oacute;rak B, Graff K. Changes in gait pattern in patients with scoliosis. Vol. 10, Medical Rehabilitation. 2006.\\u003c/li\\u003e\\n \\u003cli\\u003eChen PQ, Wang JL, Tsuang YH, Liao TL, Huang PL, Hang YS. The postural stability control and gait pattern of idiopathic scoliosis adolescents. Clinical Biomehanics. 1998;13:52\\u0026ndash;8.\\u003c/li\\u003e\\n \\u003cli\\u003eYoung-Hoon P, Chang-Hong Y, Kook-Woong S. Accuracy and Consistency of Three-Dimensional Motion Analysis System. Korean Journal of Sport Biomechanics. 2005;15:83.\\u003c/li\\u003e\\n \\u003cli\\u003eZecca M, Saito K, Sessa S, Bartolomeo L, Lin Z, Cosentino S, et al. Use of an ultra-miniaturized IMU-based motion capture system for objective evaluation and assessment of walking skills. Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS. 2013;4883\\u0026ndash;6.\\u003c/li\\u003e\\n \\u003cli\\u003eRenani MS, Myers CA, Zandie R, Mahoor MH, Davidson BS, Clary CW. Deep learning in gait parameter prediction for oa and tka patients wearing imu sensors. Sensors (Switzerland). 2020 Oct 1;20(19):1\\u0026ndash;21.\\u003c/li\\u003e\\n \\u003cli\\u003eLatajka A, Stefańska M, Woźniewski M, Malicka I. Walking Speed and Risk of Falling Patients Operated for Selected Malignant Tumors. Healthcare (Switzerland). 2023 Dec 1;11(23).\\u003c/li\\u003e\\n \\u003cli\\u003eJover-Jorge N, Gonz\\u0026aacute;lez-Rojo P, Amaya-Valero JV, Baixauli-Garc\\u0026iacute;a F, De La Calva-Cein\\u0026oacute;s C, Angulo-S\\u0026aacute;nchez M, et al. Comparative analysis of spatiotemporal gait parameters in patients with distal femoral megaprosthesis and healthy subjects using an inertial measurement unit (IMU). Wearable Technologies. 2025 Jun 13;6.\\u003c/li\\u003e\\n \\u003cli\\u003eMolt\\u0026oacute; IN, Albiach JP, Amer-Cuenca JJ, Segura-Ort\\u0026iacute; E, Gabriel W, Mart\\u0026iacute;nez-Gramage J. Wearable sensors detect differences between the sexes in lower limb electromyographic activity and pelvis 3D kinematics during running. Sensors (Switzerland). 2020 Nov 2;20(22):1\\u0026ndash;13.\\u003c/li\\u003e\\n \\u003cli\\u003eMart\\u0026iacute;nez-Gramage J, Albiach JP, Molt\\u0026oacute; IN, Amer-Cuenca JJ, Moreno VH, Segura-Ort\\u0026iacute; E. A random forest machine learning framework to reduce running injuries in young triathletes. Sensors (Switzerland). 2020 Nov 1;20(21):1\\u0026ndash;12.\\u003c/li\\u003e\\n \\u003cli\\u003eTeufl W, Miezal M, Taetz B, Frohlichi M, Bleser G. Validity of inertial sensor based 3D joint kinematics of static and dynamic sport and physiotherapy specific movements. PLoS One. 2019 Feb 1;14(2).\\u003c/li\\u003e\\n \\u003cli\\u003eAl-Amri M, Nicholas K, Button K, Sparkes V, Sheeran L, Davies JL. Inertial measurement units for clinical movement analysis: Reliability and concurrent validity. Sensors (Switzerland). 2018 Mar 1;18(3).\\u003c/li\\u003e\\n \\u003cli\\u003eLenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, et al. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis - PubMed. The Journal of Bone \\u0026amp; Joint Surgery. 2001 Oct;83(8):1169\\u0026ndash;81.\\u003c/li\\u003e\\n \\u003cli\\u003eG-WALK | Wearable inertial sensor for motion analysis | BTS [Internet]. [cited 2025 Sep 8]. Available from: https://www.btsbioengineering.com/products/g-walk/\\u003c/li\\u003e\\n \\u003cli\\u003eBrowne W, Nair BKR. The timed up and go test. Vol. 210, Medical Journal of Australia. Australasian Medical Publishing Co. Ltd; 2019.\\u003c/li\\u003e\\n \\u003cli\\u003eCasano HAM, Ahmed I, Anjum F. Six-Minute Walk Test. Kinesitherapie. 2025 Jul 7;7(68\\u0026ndash;69):68.\\u003c/li\\u003e\\n \\u003cli\\u003eCostantini S, Redaelli DF, Fraschini P, Biffi E, Storm FA. On mobility and gait in scoliosis patients: a comparison of conventional and 3D-printed braces during an instrumented timed-up and go test. BMC Musculoskelet Disord. 2025 Dec 1;26(1).\\u003c/li\\u003e\\n \\u003cli\\u003eMahaudens P, Detrembleur C, Mousny M, Banse X. Gait in thoracolumbar/lumbar adolescent idiopathic scoliosis: Effect of surgery on gait mechanisms. European Spine Journal. 2010 Jul;19(7):1179\\u0026ndash;88.\\u003c/li\\u003e\\n \\u003cli\\u003ePerry Jacquelin, Burnfield Judith. Gait Analysis: Normal and Pathological Function : Perry, Dr. Jacquelin, Burnfield, Dr. Judith: Amazon.es: Libros. 2nd ed. Slack; 2010.\\u003c/li\\u003e\\n \\u003cli\\u003eOatis CA. The Mechanics and Pathomechanics of Human Movement Second Edition.\\u003c/li\\u003e\\n \\u003cli\\u003eMacellari V, Giacomozzi C, Saggini R. Spatial-temporal parameters of gait: reference data and a statistical method for normality assessment. Gait Posture. 1999 Oct 1;10(2):171\\u0026ndash;81.\\u003c/li\\u003e\\n \\u003cli\\u003eBernardini M, Quarto G, Del Sole D, Bernardini E. Influences of postural alterations on the hemodynamic of the gait in patients with saphenous incompetence. A preliminary study - PubMed. Ann Ital Chir. 2019;90:545\\u0026ndash;50.\\u003c/li\\u003e\\n \\u003cli\\u003eByl NN, Gray JM. Complex Balance Reactions in Different Sensory Conditions: Adolescents With and Without Idiopathic Scoliosis. The Journal of Bone and Joint Surgery. Orthopaedic Research Society; 1993.\\u003c/li\\u003e\\n \\u003cli\\u003eMahaudens P, Banse X, Mousny M, Detrembleur C. Gait in adolescent idiopathic scoliosis: Kinematics and electromyographic analysis. European Spine Journal. 2009 Apr;18(4):512\\u0026ndash;21.\\u003c/li\\u003e\\n \\u003cli\\u003eRoussouly P, Gollogly S, Berthonnaud E, Dimnet J. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976) [Internet]. 2005 Feb 1 [cited 2025 Nov 20];30(3):346\\u0026ndash;53. Available from: https://journals.lww.com/spinejournal/fulltext/2005/02010/classification_of_the_normal_variation_in_the.16.aspx\\u003c/li\\u003e\\n \\u003cli\\u003eLafage V, Schwab F, Patel A, Hawkinson N, Farcy JP. Pelvic tilt and truncal inclination: Two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976) [Internet]. 2009 Aug [cited 2025 Nov 20];34(17). Available from: https://journals.lww.com/spinejournal/fulltext/2009/08010/pelvic_tilt_and_truncal_inclination__two_key.28.aspx\\u003c/li\\u003e\\n \\u003cli\\u003ePizones J, Hills J, Kelly MP, Alavi F, Nu\\u0026ntilde;ez-Pereira S, Smith JS, et al. Alignment Goals in Adult Spinal Deformity Surgery. Global Spine J [Internet]. 2025 Jul 1 [cited 2025 Nov 20];15(3_suppl):108S-122S. Available from: https://pubmed.ncbi.nlm.nih.gov/40632289/\\u003c/li\\u003e\\n \\u003cli\\u003eLaouissat F, Sebaaly A, Gehrchen M, Roussouly P. Classification of normal sagittal spine alignment: refounding the Roussouly classification. Eur Spine J [Internet]. 2018 Aug 1 [cited 2025 Nov 20];27(8):2002\\u0026ndash;11. Available from: https://pubmed.ncbi.nlm.nih.gov/28455623/\\u003c/li\\u003e\\n \\u003cli\\u003eMac-Thiong JM, Labelle H, Roussouly P. Pediatric sagittal alignment. Eur Spine J [Internet]. 2011 Aug 3 [cited 2025 Nov 23];20 Suppl 5(5):586\\u0026ndash;90. Available from: https://link.springer.com/article/10.1007/s00586-011-1925-0\\u003c/li\\u003e\\n \\u003cli\\u003eKramers-De Quervain IA, M\\u0026uuml;ller R, Stacoff A, Grob D, St\\u0026uuml;ssi E. Gait analysis in patients with idiopathic scoliosis. European Spine Journal. 2004;13(5):449\\u0026ndash;56.\\u003c/li\\u003e\\n \\u003cli\\u003eKim DS, Park SH, Goh TS, Son SM, Lee JS. A meta-analysis of gait in adolescent idiopathic scoliosis. Journal of Clinical Neuroscience. 2020 Nov 1;81:196\\u0026ndash;200.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"european-spine-journal\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"esjo\",\"sideBox\":\"Learn more about [European Spine Journal](http://link.springer.com/journal/586)\",\"snPcode\":\"586\",\"submissionUrl\":\"https://submission.springernature.com/new-submission/586/3\",\"title\":\"European Spine Journal\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false},\"keywords\":\"adolescent idiopathic scoliosis, gait analysis, inertial measurement unit, pelvic mobility, lumbopelvic rhythm, biomechanics, spinopelvic balance\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8206930/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8206930/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e\\u003cp\\u003eAdolescent idiopathic scoliosis (AIS) is the most common spinal deformity in adolescents. Severe curves (\\u0026gt;\\u0026thinsp;40\\u0026deg;) can alter spinopelvic balance and gait mechanics, although few studies have objectively quantified these effects. To analyze gait characteristics, pelvic mobility, and lumbopelvic motion patterns in patients with severe AIS compared to healthy controls using inertial measurement unit (IMU) technology, and to explore correlations between radiological and gait parameters.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e\\u003cp\\u003eA prospective study was conducted including 35 preoperative AIS patients (Cobb\\u0026thinsp;\\u0026gt;\\u0026thinsp;40\\u0026deg;) and 34 age-matched healthy controls. Each participant underwent gait analysis using a single IMU (BTS G-Sensor) performing three standardized tests: \\u003cem\\u003eUp and Go\\u003c/em\\u003e, \\u003cem\\u003eWalk\\u003c/em\\u003e, and \\u003cem\\u003e6-Minute Walk\\u003c/em\\u003e. Radiological parameters (Cobb angles, pelvic incidence, tilt, and sacral slope) were recorded. Statistical comparisons were performed.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e\\u003cp\\u003eAIS patients showed significantly greater accelerations during standing-up and sitting-down transitions and reduced trunk flexion\\u0026ndash;extension ranges (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). The control group exhibited greater gait symmetry and smaller pelvic tilt ranges. Gait speed and total distance in the \\u003cem\\u003e6-Minute Walk\\u003c/em\\u003e test were significantly lower in AIS patients (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05).\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e\\u003cp\\u003eSevere AIS alters lumbopelvic rhythm and gait kinematics, producing compensatory patterns characterized by increased pelvic mobility and reduced trunk flexion. IMU-based motion analysis enables objective and reproducible evaluation of these biomechanical changes, offering a valuable clinical tool for preoperative assessment and rehabilitation planning.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Quantifying Gait and Mobility in Severe Idiopathic Scoliosis with Inertial Measurement Technology\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-12-11 09:25:27\",\"doi\":\"10.21203/rs.3.rs-8206930/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2026-01-14T16:21:07+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-01-13T17:09:47+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"75686959613859121147280454525641488355\",\"date\":\"2025-12-15T13:43:40+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-12-12T05:40:48+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"249364023190301320167196273406536375615\",\"date\":\"2025-12-09T02:52:23+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-12-08T15:48:29+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-11-27T12:25:15+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-11-27T12:19:33+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"European Spine Journal\",\"date\":\"2025-11-25T22:16:14+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"european-spine-journal\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"esjo\",\"sideBox\":\"Learn more about [European Spine Journal](http://link.springer.com/journal/586)\",\"snPcode\":\"586\",\"submissionUrl\":\"https://submission.springernature.com/new-submission/586/3\",\"title\":\"European Spine Journal\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false}}],\"origin\":\"\",\"ownerIdentity\":\"8b7b7dd1-20b9-4805-b4f6-629ca48736ac\",\"owner\":[],\"postedDate\":\"December 11th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-04-13T16:15:55+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-8206930\",\"link\":\"https://doi.org/10.1007/s00586-026-09890-5\",\"journal\":{\"identity\":\"european-spine-journal\",\"isVorOnly\":false,\"title\":\"European Spine Journal\"},\"publishedOn\":\"2026-04-06 15:56:58\",\"publishedOnDateReadable\":\"April 6th, 2026\"},\"versionCreatedAt\":\"2025-12-11 09:25:27\",\"video\":\"\",\"vorDoi\":\"10.1007/s00586-026-09890-5\",\"vorDoiUrl\":\"https://doi.org/10.1007/s00586-026-09890-5\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8206930\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8206930\",\"identity\":\"rs-8206930\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}