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Boerger TF, McGinn L, Bellman M, Wang MC, Schmit BD, Hyngstrom AS. People with degenerative cervical myelopathy have impaired reactive balance during walking. Gait Posture 2024; 109:303-310. [PMID: 38412683 PMCID: PMC11181995 DOI: 10.1016/j.gaitpost.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/30/2024] [Accepted: 02/19/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND People with degenerative cervical myelopathy are known to have impaired standing balance and walking abilities, but less is known about balance responses during walking. RESEARCH QUESTION The aim of this project was to assess reactive balance impairments during walking in people with degenerative cervical myelopathy (PwDCM). We hypothesized that center of mass motion following perturbations would be larger in PwDCM and gluteus medius electromyographic amplitude responses would be decreased in PwDCM. METHODS Reactive balance responses were quantified during unanticipated lateral pulls to the waist while treadmill walking. Walking biomechanics data were collected from 10 PwDCM (F=6) and 10 non-myelopathic controls (F=7) using an 8 camera Vicon System (Vicon MX T-Series). Electromyography was collected from lower limb muscles. Participants walked on an instrumented treadmill and received lateral pulls at random intervals and in randomized direction at 5% and 2.5% body mass. Participants walked at 3 prescribed foot placements to control for effects of the size of base of support. RESULTS As compared with controls, the perturbation-related positional change of the center of mass motion (ΔCOM) was increased in PwDCM (p=0.001) with similar changes in foot placement (p>0.05). Change in gluteus medius electromyography, however, was less in PwDCM than in controls (p<0.001). SIGNIFICANCE After experimentally controlling step width, people with mild-to-moderate degenerative cervical myelopathy at least 3 months following cervical spine surgery have impaired reactive balance during walking likely coupled with reduced gluteus medius electromyographic responses. Rehabilitation programs focusing on reactive balance and power are likely necessary for this population.
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Affiliation(s)
| | - Learon McGinn
- Department of Physical Therapy, Marquette University, USA
| | - Megan Bellman
- Department of Neurosurgery, Medical College of Wisconsin, USA
| | - Marjorie C Wang
- Department of Neurosurgery, Medical College of Wisconsin, USA
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University, USA
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Khan Z, Jiao X, Hu T, Shao Q, Sun X, Zhao X, Gu D. Investigation of gait, balance and lower extremity muscle activity during walking in patients with cervical spondylotic myelopathy using wearable sensors. Spine J 2023:S1529-9430(23)00106-7. [PMID: 36934793 DOI: 10.1016/j.spinee.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/28/2023] [Accepted: 03/10/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND CONTEXT Cervical spondylotic myelopathy (CSM) is a degenerative disease caused by cervical cord compression and can lead to the significant impairment of motor function including gait and balance disturbances and changes in lower extremity muscle activity. PURPOSE This study aimed to characterize gait, balance and lower extremity muscle activity in patients with CSM compared to age-matched healthy controls (HCs) using wearable sensors in the clinical setting. STUDY DESIGN Non-Randomized, prospective cohort study. PATIENT SAMPLE 10 CSM patients and 10 age-matched HCs were recruited for this study. OUTCOME MEASURES Gait and balance function parameters contained spatial temporal parameters, step regularity (SR1), stride regularity (SR2) and harmonic ratio (HR). EMG muscle activity parameters included time to peak and peak value during loading, stance, and swing phase. METHODS In this study, parameters of gait and balance function were extracted using triaxial accelerometer attached to the spinous processes of Lumbar 5 while participants performed an overground walking at a self-preferred speed. Moreover, muscular activity was simultaneously recorded via sEMG sensors attached to tibialis anterior (TA), rectus femoris (RF), bicep femoris (BF) and gastrocnemius lateral (GL). Independent sample t-test was used to find the differences between CSM patients and HCs. RESULTS Gait analysis showed cadence, step length and walking speed were statistically significantly lower in CSM patients than HCs. Stride time was significantly higher for CSM patients in comparison to HCs. Lower root mean square ratio (RMSR) of acceleration in the mediolateral (ML) direction, HR in the anteroposterior (AP) direction, SR1 in the AP direction and SR2 in all three directions were observed in CSM patients. For muscle activity analysis, EMG RMS for TA and RF during loading phase and RMS for GL during midstance phase was significantly lower for CSM patients, while significantly higher value was observed for RF RMS during midstance phase and GL RMS during swing phase in CSM patients. CONCLUSION Our pilot study shows that wearable sensors are able to detect the changes of gait, balance and lower extremity muscle activities of CSM patients in the clinical setting. This pilot study sets the stage for future researches on the diagnosis and monitor progression of CSM disease using wearable technology.
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Affiliation(s)
- Zawar Khan
- Shanghai Key Laboratory of Orthopaedic Implants and Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China; School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
| | - Xin Jiao
- Shanghai Key Laboratory of Orthopaedic Implants and Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China; School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
| | - Tianyi Hu
- Shanghai Key Laboratory of Orthopaedic Implants and Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China; School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
| | - Qineng Shao
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
| | - Xin Sun
- Shanghai Key Laboratory of Orthopaedic Implants and Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Xin Zhao
- Shanghai Key Laboratory of Orthopaedic Implants and Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China.
| | - Dongyun Gu
- Shanghai Key Laboratory of Orthopaedic Implants and Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China; School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China.
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Kinematic Analysis of the Forward Head Posture Associated with Smartphone Use. Symmetry (Basel) 2023. [DOI: 10.3390/sym15030667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background: Frequent use of mobile devices has a known association with musculoskeletal neck pain. This study sought out to localize the region with greatest flexion in the cervical spine and explored the role of symmetry in maintaining the pose during texting. Methods: Three inertial measuring units (IMUs) superficially attached along the cervical spine divided the cervical spine into two measurable segments. Twenty-five subjects participated in the study and performed three tasks when using smartphones: sitting, standing, and walking. Data from each IMU were used to calculate the flexion of cervical divided into two segments: craniocervical junction (C0–C1) and subaxial (C1–C7). Results: The greatest flexion by far occurred at C0–C1. While sitting, standing, and walking, the mean flexion angles were 33.33 ± 13.56°, 27.50 ± 14.05°, and 32.03 ± 10.03° for the C0–C1 joint and −3.30 ± 10.10°, 2.50 ± 9.99°, and −1.05 ± 11.88° for the C2–C7 segment, respectively. There is a noticeable pattern of yaw movement of the head, with a slow rotation toward symmetry and a fast corrective movement toward the smartphone held in one hand. Conclusions: This study identified the region of greatest contribution toward forward flexion along the cervical parameters during various tasks involving smartphone use. With each task, the greatest contributor to head flexion was the C0–C1 joint. There is involuntary rotation of the cervical spine toward symmetry when texting.
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Yu Z, Pan W, Chen J, Peng X, Ling Z, Zou X. Application of electrophysiological measures in degenerative cervical myelopathy. Front Cell Dev Biol 2022; 10:834668. [PMID: 36016659 PMCID: PMC9395596 DOI: 10.3389/fcell.2022.834668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
Degenerative cervical myelopathy (DCM) is one of the leading causes of progressive spinal cord dysfunction in the elderly. Early diagnosis and treatment of DCM are essential to avoid permanent disability. The pathophysiology of DCM includes chronic ischemia, destruction of the blood–spinal cord barrier, demyelination, and neuronal apoptosis. Electrophysiological studies including electromyography (EMG), nerve conduction study (NCS), motor evoked potentials (MEPs) and somatosensory evoked potentials (SEPs) are useful in detecting the presymptomatic pathological changes of the spinal cord, and thus supplementing the early clinical and radiographic examinations in the management of DCM. Preoperatively, they are helpful in detecting DCM and ruling out other diseases, assessing the spinal cord compression level and severity, predicting short- and long-term prognosis, and thus deciding the treatment methods. Intra- and postoperatively, they are also useful in monitoring neurological function change during surgeries and disease progression during follow-up rehabilitation. Here, we reviewed articles from 1979 to 2021, and tried to provide a comprehensive, evidence-based review of electrophysiological examinations in DCM. With this review, we aim to equip spinal surgeons with the basic knowledge to diagnosis and treat DCM using ancillary electrophysiological tests.
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Affiliation(s)
- Zhengran Yu
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Department of Spine Surgery, Orthopedics Center of Guangdong Provincial People’s Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wenxu Pan
- Department of Gastroenterology, Guangzhou Women and Children’s Medical Center, Jinan University, Guangzhou, China
| | - Jiacheng Chen
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xinsheng Peng
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zemin Ling
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- *Correspondence: Zemin Ling, ; Xuenong Zou, ,
| | - Xuenong Zou
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- *Correspondence: Zemin Ling, ; Xuenong Zou, ,
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Yano T, Fujishiro T, Obo T, Nakano A, Nakaya Y, Hayama S, Mori K, Baba I, Neo M. The Effects of Surgery on Postural Instability in Patients With Cervical Compressive Myelopathy: Evaluating Subjective Perceptions and Objective Measurements. Clin Spine Surg 2022; 35:E298-E305. [PMID: 34039889 DOI: 10.1097/bsd.0000000000001195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To investigate the effects of surgery on the subjective perception of bodily unsteadiness and the objective measurements of postural instability in patients with cervical compressive myelopathy (CCM). SUMMARY OF BACKGROUND DATA Several studies have demonstrated that CCM patients have impaired postural stability and investigated its surgical outcomes. However, these studies have only objectively measured postural stability by using a stabilometer or three-dimensional motion capture system. There have been no studies examining the subjective perception of postural instability in CCM patients. MATERIALS AND METHODS We retrospectively reviewed patients who underwent decompressive surgery for CCM. The Fall Efficacy Scale-International (FES-I) and a self-prepared questionnaire were used to evaluate subjective perception of bodily unsteadiness. To objectively assess postural instability, a stabilometric analysis was performed with the following parameters: sway area (SwA, cm2), sway velocity (SwV, cm/s), and sway density (SwD, /cm). The evaluations were performed preoperatively, during the early postoperative period (3-6 mo postoperatively), and at 1-year postoperatively in patients with CCM. The evaluation results were compared with age-matched, sex-matched, and body mass index-matched healthy subjects. RESULTS We included 70 CCM patients and 36 healthy subjects in this study. In both the FES-I and self-prepared questionnaire, CCM patients reported significantly milder postoperative bodily unsteadiness. The stabilometric parameters were significantly improved during the postoperative period when compared with preoperative values. Nevertheless, neither the self-reported outcome measures nor stabilometric parameters of CCM patients reached the levels of those in healthy controls in the postoperative period. CONCLUSION This was the first study to examine CCM surgical outcomes in terms of both subjective perception and objective postural instability. While both objective postural stability and subjective perception improved following decompressive surgery, they did not reach the levels seen in healthy participants. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Toma Yano
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
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Boerger TF, McGinn L, Wang MC, Schmit BD, Hyngstrom AS. Degenerative cervical myelopathy delays responses to lateral balance perturbations regardless of predictability. J Neurophysiol 2022; 127:673-688. [PMID: 35080466 PMCID: PMC8897012 DOI: 10.1152/jn.00159.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to quantify balance impairments in standing in people with degenerative cervical myelopathy (PwDCM) in response to external perturbations. PwDCM have damage to their spinal cord due to degeneration of the cervical vertebral column, but little is known about balance. Balance was quantified by capturing kinetics, kinematic, and electromyographic data during standing in response to lateral waist pulls. Participants received pulls during predictable and unpredictable contexts in three stance widths at two magnitudes. In response to lateral waist pulls, PwDCM had larger center of mass excursion (P < 0.001) and delayed gluteus medius electromyography onset (P < 0.001) and peak (P < 0.001) timing. These main effects of history of myelopathy were consistent across predictability, stance width, and magnitude. A multilinear regression determined that gluteus medius peak timing + tibialis anterior peak timing most strongly predicted center of mass excursion (R2 = 0.50, P < 0.001). These data suggest that PwDCM have delays in generating voluntary and reactive motor commands, contributing to balance impairments. Future rehabilitation strategies should focus on generating rapid muscular contractions. Additionally, frontal plane postural control is regulated by the gluteus medius and the tibialis anterior, whereas other muscles (e.g. gluteus minimus, ankle invertors/evertors) not studied here may also contribute.NEW & NOTEWORTHY Frontal plane reactive postural control is impaired in persons with degenerative cervical myelopathy because of delayed muscle responses. Additionally, postural control varies across stance width, predictability, and perturbation magnitude.
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Affiliation(s)
- T. F. Boerger
- 1Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - L. McGinn
- 2Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin
| | - M. C. Wang
- 1Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - B. D. Schmit
- 3Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin
| | - A. S. Hyngstrom
- 2Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin
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Hassanzadeh H, Bell J, Dooley E, Puvanesarajah V, Kamalapathy P, Labaran L, Shimer A, Shen F, Russell S. Evaluation of Gait and Functional Stability in Preoperative Cervical Spondylotic Myelopathy Patients. Spine (Phila Pa 1976) 2022; 47:317-323. [PMID: 34593732 DOI: 10.1097/brs.0000000000004235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE The aim of this study was to 1) determine postural stability and spatiotemporal gait parameters and 2) characterize dynamic stability and variances in angular momentum (AM) of preoperative cervical spondylotic myelopathy (CSM) patients compared with healthy controls. SUMMARY OF BACKGROUND DATA CSM is the most common cause of spinal cord dysfunction in the world and can lead to significant functional deficits including proprioception and gait disturbances. Biomechanical feedback mechanisms compensating for these deficits, specifically AM regulation, have remained largely unexplored. METHODS Fifty-six subjects: 32 preoperative Nurick grade 2 or 3 CSM patients and 24 controls were included. Standing balance trials were performed on a single force plate, while walking trials were conducted at self-selected pace over a 15 m runway and a series of five force plates. All trials were recorded with three-dimensional motion analysis cameras and gait modeling software was utilized to calculate stability, spatiotemporal gait parameters, and joint kinematics. RESULTS Tilted ellipse area, a measure of center of pressure variance and postural stability, was significantly greater among CSM patients (847.54 ± 764.33 mm2vs. 258.18 ± 103.35 mm2, P < 0.001). These patients had two times as much variance medial-lateral (72.12 ± 51.83 mm vs. 29.15 ± 14.95 mm, P = 0.001) and over three times as much anterior-posterior (42.25 ± 55.01 mm vs. 9.17 ± 4.83 mm, P = 0.001) compared with controls. Spatiotemporal parameters indicated that the CSM patients tending to have slower, shorter, and wider gait compared with controls, while spending greater amount of time in double support. Compensatory AM among CSM patients was significantly increased in all three anatomic planes, where whole-body AM was approximately double that of controls (0.057 ± 0.034 vs. 0.023 ± 0.006), P < 0.001). CONCLUSION Preoperative CSM patients showed significant alterations in spatiotemporal gait parameters and postural stability compared with controls, consistent with prior literature. Likewise, angular momentum analysis demonstrates that these patients have globally increased body excursion to maintain dynamic balance.Level of Evidence: 3.
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Affiliation(s)
- Hamid Hassanzadeh
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Joshua Bell
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Evan Dooley
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | | | - Pramod Kamalapathy
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Lawal Labaran
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Adam Shimer
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Francis Shen
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Shawn Russell
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
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Haddas R, Kosztowski T, Mar D, Boah A, Lieberman IH. Balance effort, Cone of Economy, and dynamic compensatory mechanisms in common degenerative spinal pathologies. Gait Posture 2021; 89:67-73. [PMID: 34243138 DOI: 10.1016/j.gaitpost.2021.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 03/30/2021] [Accepted: 04/21/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Changes in balance are common in individuals with spinal disorders and may cause falls. Balance efficiency, is the ability of a person to maintain their center of gravity with minimal neuromuscular energy expenditure, oftentimes referred to as Cone of Economy (CoE). CoE balance is defined by two sets of measures taken from the center of mass (CoM) and head: 1) the range-of-sway (RoS) in the coronal and sagittal planes, and 2) the overall sway distance. This allows spine caregivers to assess the severity of a patient's balance, balance pattern, and dynamic posture and record the changes following surgical intervention. Maintenance of balance requires coordination between the central nervous and musculoskeletal systems. RESEARCH QUESTION To discern differences in balance effort values between common degenerative spinal pathologies and a healthy control group. METHODS Three-hundred and forty patients with degenerative spinal pathologies: cervical spondylotic myelopathy (CSM), adult degenerative scoliosis (ADS), sacroiliac dysfunction (SIJD), degenerative lumbar spondylolisthesis (DLS), single-level lumbar degeneration (LD), and failed back syndrome (FBS), and 40 healthy controls were recruited. A functional balance test was performed approximately one week before surgery recorded by 3D video motion capture. RESULTS Balance effort and compensatory mechanisms were found to be significantly greater in degenerative spinal pathologies patients compared to controls. Head and Center of Mass (CoM) overall sway ranged from 65.22 to 92.78 cm (p < 0.004) and 35.77-53.31 cm (p < 0.001), respectively in degenerative spinal pathologies patients and in comparison to controls (Head: 44.52 cm, CoM: 22.24 cm). Patients with degenerative spinal pathologies presented with greater trunk (1.61-2.98°, p < 0.038), hip (4.25-5.87°, p < 0.049), and knee (4.55-6.09°, p < 0.036) excursion when compared to controls (trunk: 0.95°, hip: 2.97°, and knee: 2.43°). SIGNIFICANCE The results of this study indicate that patients from a wide variety of degenerative spinal pathologies similarly exhibit markedly diminished balance (and compensatory mechanisms) as indicated by increased sway on a Romberg test and a larger Cone of Economy (CoE) as compared to healthy controls. Balance effort, as measured by overall sway, was found to be approximately double in patients with degenerative spinal pathologies compared to healthy matched controls. Clinicians can compare CoE parameters among symptomatic patients from the different cohorts using the Haddas' CoE classification system to guide their postoperative prognosis.
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Affiliation(s)
| | | | - Damon Mar
- Texas Back Institute, Plano, TX, USA
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Haddas R, Wood A, Mar D, Derman P, Lieberman I. Reporting and tracking objective functional outcome measures: implementation of a summary report for gait and balance measures. Spine J 2021; 21:1193-1204. [PMID: 33631256 DOI: 10.1016/j.spinee.2021.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 02/03/2023]
Abstract
The aim of this manuscript is to describe knowledge gaps in the literature, future directions, and emerging applications of gait and balance analysis in spine surgery with regard to functional outcomes measurement. Functional outcome measurement has been established as a useful clinical and research investigational tool in musculoskeletal disease. Evidence currently supports its use in the diagnosis, treatment, and outcome measurement of multiple musculoskeletal disease states, including spinal disease, and its usefulness continues to grow as literature develops. Gait and balance analysis has proven to be broadly applicable, but most clinicians remain unfamiliar and untrained in its usage. The logistical and communication barriers are also described with the potential solutions that are on the near horizon of research. This article describes our methodology for improving conveyance of functional outcome measures in spine surgery. Additionally, we provide a case example of an adult patient with spinal deformity who is examined pre and post operatively using our methodology.
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Affiliation(s)
| | - Addison Wood
- UNT Health Science Center, Fort Worth, TX, USA; John Peter Smith Hospital, Fort Worth, TX, USA
| | - Damon Mar
- Texas Back Institute, Plano, TX, USA
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Haddas R, Wood A, Lieberman I, Derman PB. Assessing the cone of economy in patients with spinal disease using only a force plate: an observational retrospective cohort study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2504-2513. [PMID: 33877453 DOI: 10.1007/s00586-021-06836-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 03/15/2021] [Accepted: 04/03/2021] [Indexed: 11/24/2022]
Abstract
STUDY DESIGN This is a retrospective cohort with multiple regression modeling. OBJECTIVE The aim is to develop a new method for estimating cone of economy (CoE) using a force plate rather than traditional motion capture. BACKGROUND Currently, most spinal deformity surgeons rely on static radiographic parameters for alignment, balance, and outcomes data alongside patient-reported outcome measures. The CoE, the stable region of upright posture, can be objectively measured to determine the efficiency and balance of the spine. Motion capture technology is currently used to collect data to calculate CoE, but this requires expensive and complex equipment, which is a barrier to widespread adoption and clinical use of CoE measurements. Force plates, which measure pressure, are less expensive and can be used in a clinical setting. METHODS Motion capture and a force plate were used to quantify the CoE of 473 subjects (423 spinal surgical candidates; 50 healthy controls; 271 females; age: 58.60 ± 15.27; height: 1.69 ± 0.13; weight: 81.07 ± 20.91), and a linear multiple regression model was used to predict CoE using force plate data in a human motion laboratory setting. Patients were required to stand erect with feet together and eyes open in their self-perceived balanced and natural position for a full minute while measures of sway and center of pressure (CoP) were recorded. RESULTS The CoP variable regression model successfully predicted CoE measurements. The variables that were used to predict vertical CoE were CoP coronal sway, CoP sagittal sway, and CoP total sway in several combinations. The coefficient of determination for the head total sway model indicated a 87.0% correlation (F(3,469) = 1044.14, p < 0.001). The coefficient of determination for the head sagittal sway model indicated a 69.2% correlation (F(3,469) = 351.70, p < 0.001). The coefficient of determination for the head coronal sway model indicated a 85.2% correlation (F(3,469) = 899.27, p < 0001). CONCLUSION Cone of economy was estimated from force plate data using center of pressure with high correlation without the use of motion capture in healthy controls and a variety of spine patients. This could lower the entry burden for measurement of the CoE in patients, enabling widespread use. This would provide surgeons objective global balance data, along with Haddas' CoE classification system, that could assist with surgical decision-making and facilitate objective monitoring surgical outcomes.
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Affiliation(s)
- Ram Haddas
- Texas Back Institute, 6020 West Parker Road, Plano, TX, 75093, USA.
| | - Addison Wood
- UNT Health Science Center, Fort Worth, TX, USA.,John Peter Smith Hospital, Fort Worth, TX, USA
| | - Isador Lieberman
- Texas Back Institute, 6020 West Parker Road, Plano, TX, 75093, USA
| | - Peter B Derman
- Texas Back Institute, 6020 West Parker Road, Plano, TX, 75093, USA
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Cone of economy classification: evolution, concept of stability, severity level, and correlation to patient-reported outcome scores. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2271-2282. [PMID: 33389136 DOI: 10.1007/s00586-020-06678-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/23/2020] [Accepted: 11/22/2020] [Indexed: 12/18/2022]
Abstract
STUDY DESIGN A prospective cohort study OBJECTIVE: To determine a classification system for cone of economy (CoE) measurements that defines clinically significant changes in altered balance and to assess if the CoE measurements directly impacts patients reported outcome measures (PROMs). Preoperative functional data is a crucial component of determining patient disability and prognosis. The CoE has been theorized to be the foundation of biomechanical changes that leads to increased energy expenditure and disability in spine patients. PROMs have been developed to quantify the level of debilitation in spine patients but have various limitations. METHODS A total of 423 symptomatic adult patients with spine pathology completed a series of PROMs preoperatively including VAS, ODI, Tampa Scale for Kinesiophobia (TSK), Fear and Avoidance Beliefs Questionnaire (FABQ), and Demoralization (DS). Functional balance was tested in this group using a full-body reflective marker set to measure head and center of mass (CoM) sway. RESULTS PROMs scores were correlated with the magnitude of the CoE measurements. Patients were separated by the following proposed classification: CoM coronal sway > 1.5 cm, CoM sagittal sway > 3.0 cm, CoM total sway > 30.0 cm, head coronal sway > 3.0 cm, head sagittal sway > 6.0 cm, and head total sway > 60.0 cm. Significant differences were noted in the ODI (< 0.001), FABQ physical activity (< 0.001-0.009), DS (< 0.001-0.023), and TSK (< 0.001-0.032) across almost all planes of motion for both CoM and head sway. The ODI was most sensitive to the difference between groups across CoM and head sway planes with a mean ODI of 47.5-49.5 (p < 0.001) in the severe group versus 36.6-39.3 (p < 0.001) in the moderate group. CONCLUSIONS By classifying CoE measurements by the cutoffs proposed, clinically significant alterations in balance can be quantified. Furthermore, this study demonstrates that across spinal pathology, higher magnitude CoE and range of sway measurements correlate with worsening PROMs. The Haddas' CoE classification system in this study helps to identify patients that may benefit from surgery and guide their postoperative prognosis.
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Haddas R, Kisinde S, Mar D, Lieberman I. Does improved radiographic alignment truly enhance dynamic functional balance? Spine Deform 2020; 8:685-694. [PMID: 32065379 DOI: 10.1007/s43390-020-00089-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
STUDY DESIGN Prospective concurrent cohort study. OBJECTIVE To establish the relationship between radiographic alignment parameters and functional CoE measurements at 1 week before and at 3 months after realignment surgery in ADS patients. Adult degenerative scoliosis (ADS) represents a significant healthcare burden with exceedingly high and increasing prevalence, particularly among the elderly. Radiographic alignment measures and patient-reported outcomes currently serve as the standard means to assess spinal alignment, deformity, and stability. Neurological examinations have served as qualitative measures for indicating muscle strength, motor deficits, and gait abnormalities. Three-dimensional motion analysis is increasingly being used to identify and measure gait and balance instability. Recently, techniques have been established to quantify balance characteristics described by Dubousset as the "cone of economy" (CoE). The relationship between radiographic alignment parameters and CoE balance measures of ADS patients before and after realignment surgery is currently unknown. PATIENT SAMPLE 29 ADS patients treated with realignment surgery. METHODS Patients were evaluated at 1 week before realignment surgery and at their 3-month follow-up examination. During each evaluation, patients completed self-reported outcomes (visual analog scales for pain, Oswestry Disability Index, SRS22r) and a functional balance test. Mean changes in dependent measures from before to after surgery were compared using paired t tests. Pearson correlations were used to test for significant correlations between changes in radiographic and CoE measures. RESULTS Significant improvements were found for all patient-reported outcomes, in several radiographic measures, and in CoE measures. Improvements of scoliosis Cobb angle, coronal pelvic tilt, lumbar lordosis, and thoracic kyphosis showed significant correlations with CoE sway and total distance measures at both the center of mass and center of the head. CONCLUSION Improved radiographic alignment measures significantly correlated with improved CoE balance measures among ADS patients treated with realignment surgery at their three-month follow-up. These findings indicate that functional balance evaluations when used in conjunction with radiographic measurements, may provide a more robust and improved patient-specific sensitivity for postoperative assessments. CoE balance may represent a new measure of added value for surgical intervention of ADS.
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Affiliation(s)
- Ram Haddas
- Texas Back Institute, 6020 West Parker Road, Plano, TX, 75093, USA.
| | - Stanley Kisinde
- Texas Back Institute, 6020 West Parker Road, Plano, TX, 75093, USA
| | - Damon Mar
- Texas Back Institute, 6020 West Parker Road, Plano, TX, 75093, USA
| | - Isador Lieberman
- Texas Back Institute, 6020 West Parker Road, Plano, TX, 75093, USA
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van Ballegoij WJC, van de Stadt SIW, Huffnagel IC, Kemp S, van der Knaap MS, Engelen M. Postural Body Sway as Surrogate Outcome for Myelopathy in Adrenoleukodystrophy. Front Physiol 2020; 11:786. [PMID: 32765293 PMCID: PMC7379508 DOI: 10.3389/fphys.2020.00786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/15/2020] [Indexed: 11/13/2022] Open
Abstract
Background Myelopathy is the core clinical manifestation of adrenoleukodystrophy (ALD), which is the most common peroxisomal disorder. Development of therapies requires sensitive and clinically relevant outcome measures. Together with spastic paraparesis, balance disturbance is the main cause of disability from myelopathy in ALD. In this cross-sectional study, we evaluated whether postural body sway - a measure of balance - could serve as a surrogate outcome in clinical trials. Methods Forty-eight male ALD patients and 49 age-matched healthy male controls were included in this study. We compared sway amplitude and sway path of ALD patients to controls. We then correlated the body sway parameters showing the largest between-group differences with clinical measures of severity of myelopathy. To correct for age, we performed multiple linear regression analysis with age and severity of myelopathy as independent variables. Results All body sway parameters were significantly higher in patients than in controls, with medium to large effect sizes (r = 0.43-0.66, p < 0.001). In the subgroup of asymptomatic patients, body sway amplitude was also higher, but the difference with controls was smaller than for symptomatic patients (effect size r = 0.38-0.46). We found moderate to strong correlations between body sway amplitude and clinical severity of myelopathy (r = 0.40-0.79, p < 0.005). After correction for age, severity of myelopathy was a significant predictor of body sway amplitude in all regression models. Conclusions These results indicate that postural body sway may serve as a surrogate outcome for myelopathy in ALD. Such outcomes are important to evaluate new therapies in clinical trials. Further longitudinal studies are needed and ongoing in this cohort.
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Affiliation(s)
- Wouter J C van Ballegoij
- Department of Pediatric Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Department of Neurology, OLVG Hospital, Amsterdam, Netherlands
| | - Stephanie I W van de Stadt
- Department of Pediatric Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Irene C Huffnagel
- Department of Pediatric Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Stephan Kemp
- Department of Pediatric Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam University Medical Centers, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, Netherlands
| | - Marjo S van der Knaap
- Department of Pediatric Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Department of Functional Genomics, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marc Engelen
- Department of Pediatric Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
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Haddas R, Lieberman I, Block A, Derman P. The Effect of Surgical Decompression and Fusion on Functional Balance in Patients With Degenerative Lumbar Spondylolisthesis. Spine (Phila Pa 1976) 2020; 45:E878-E884. [PMID: 32609471 DOI: 10.1097/brs.0000000000003436] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE To quantify the effect of lumbar decompression and fusion surgery on balance and stability in patients with degenerative lumbar spondylolisthesis (DLS) and compare them to controls. SUMMARY OF BACKGROUND DATA DLS is a condition in which one vertebra subluxates relative to an adjacent vertebra in the absence of a disruption in the neural arch. While the existing literature demonstrates that decompression and fusion can successfully alleviate pain and reduce disability in patients with DLS, no studies to date have used quantitative dynamic testing to determine the effect of surgery on cone of economy (CoE) measures in this patient population. METHODS Forty-five DLS patients performed a series of functional balance tests a week before and 3 months after surgery and were compared to 28 controls. The outcome measures included range of sway (RoS) and total sway for the center of mass (CoM) and head in the sagittal, coronal, and axial planes, along with leg and back Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Fear/Avoidance Behavior Questionnaire (FABQ), Tampa Scale of Kinesophobia (TSK), and Demoralization scale. RESULTS RoS for the CoM (P < 0.005) and head (P < 0.017) decreased in all planes postoperatively. Reductions in CoM (P = 0.001) and head total sway (P = 0.001) were also observed after surgery. Furthermore, patients with DLS reported strong improvements in VAS low back (P = 0.001), VAS leg (P = 0.001), ODI (P = 0.001), FABQ Physical (P = 0.003), TSK (P = 0.001), and demoralization (P = 0.044) with surgical intervention. Although total sway was reduced after surgery, it did not return to the level of normal controls as demonstrated with more total sway of their CoM (P = 0.002) and head (P = 0.001) as well as more sagittal head RoS (P = 0.048). CONCLUSION This study confirms that surgical intervention for degenerative spondylolisthesis is effective at reducing disability, back and leg pain, demoralization, kinesiophobia, and fear-avoidance beliefs related to physical activity in patients with DLS. Furthermore, such patients exhibit a significantly more stable stance after surgery. However, balance parameters did not completely normalize by 3 months postoperatively. LEVEL OF EVIDENCE 3.
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15
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What is actually happening inside the "cone of economy": compensatory mechanisms during a dynamic balance test. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2319-2328. [PMID: 32306304 DOI: 10.1007/s00586-020-06411-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/20/2020] [Accepted: 04/04/2020] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN A nonrandomized, prospective, concurrent control cohort study. OBJECTIVE To further develop cone of economy (CoE) measurements by identifying compensatory mechanisms at the extremes of the CoE and comparing balance control strategies in a group of adult degenerative scoliosis (ADS) patients with non-scoliotic controls. The CoE concept was first proposed by Dubousset and is frequently referred to when assessing balance in spinal deformity patients. Recently, a method that quantifies the CoE of individual patients through 3D video kinematic and electromyography data was developed. However, this method lacks measurements that describe the motor control strategies utilized by spinal disorder patients to maintain balance. PATIENT SAMPLE Twenty ADS patients and 15 non-scoliotic controls. METHODS All test subjects were fitted with a full body marker set. Each subject performed a series of functional balance tests (Romberg's with eyes opened) while being recorded in a human motion capture system. Three-dimensional CoE dimensions, range of sway (RoS), overall sway and lower extremity and trunk range of motion (RoM) were measured and analyzed. RESULTS Patients with ADS demonstrated greater overall sway and RoS in the sagittal and coronal planes compared to controls. Moreover, ADS patients presented with more hip flexion and trunk flexion at maximal points of sway and more ankle, knee, hip and trunk RoM when swaying in comparison with controls. CONCLUSIONS ADS patients have larger CoE dimensions and increased sway when compared to non-scoliotic controls. ADS patients rely on a hip balance control "strategy" and lower extremity RoM to maintain balance, which differed from control subjects. Unlike prior attempts to define compensatory mechanisms in ADS patients, the described technique utilizes dynamic, three-dimensional measurements to define what is occurring within the CoE. By expanding on prior CoE measurements, we were able to define a unique dynamic balance control strategy for each patient.
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Cheng YS, Chien A, Lai DM, Lee YY, Cheng CH, Wang SF, Chang YJ, Wang JL, Hsu WL. Perturbation-Based Balance Training in Postoperative Individuals With Degenerative Cervical Myelopathy. Front Bioeng Biotechnol 2020; 8:108. [PMID: 32154235 PMCID: PMC7044125 DOI: 10.3389/fbioe.2020.00108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/03/2020] [Indexed: 11/28/2022] Open
Abstract
Degenerative cervical myelopathy (DCM) is a common aging condition caused by spinal cord compression. Individuals with DCM often presented with residual balance and functional impairments postoperatively. Perturbation-based balance training (PBT) has been shown to have positive effects on populations with neurological disorders but has yet to be investigated in DCM. The objective of this study was therefore to evaluate the effects of PBT on balance and functional performance in postoperative individuals with DCM. Fifteen postoperative individuals with DCM (DCM group) and 14 healthy adults (healthy control group) were recruited. The DCM group received a 4-weeks PBT using a perturbation treadmill. The outcome measures included mean velocity of center of pressure (COP) during quiet standing; center of mass (COM) variance and reaction time to balance perturbation during standing with forward and backward perturbation; gait speed during level ground walking; Timed Up and Go Test (TUG) and disability questionnaire scores including Visual Analog Scale, Neck Disability Index, and Lower Extremity Function of Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire. The assessments were conducted pre- and post-training postoperatively for the DCM group but only once for the healthy control group. Significant improvements were observed in the mean velocity of COP, COM variance, reaction time, gait speed, and TUG in the DCM group. Disability questionnaire scores were not significantly different after training in DCM group. For between-group comparisons, significant differences that were observed pre-training were not observed post-training. The 4-weeks PBT is a potential rehabilitation strategy for addressing balance and functional impairment in postoperative individuals with DCM. In addition, the post-training performance in the DCM group exhibited trends comparable to those of age-matched healthy controls. Furthermore, the training regimens offer a practical reference for future studies on populations with balance disorders. Future studies complemented with neurophysiological assessments could reveal more information of the underlying mechanisms of PBT.
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Affiliation(s)
- Yi-Shan Cheng
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Andy Chien
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
| | - Dar-Ming Lai
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Yun Lee
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Hsiu Cheng
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shwu-Fen Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Ju Chang
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jaw-Lin Wang
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan
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The Correlation of Spinopelvic Parameters With Biomechanical Parameters Measured by Gait and Balance Analyses in Patients With Adult Degenerative Scoliosis. Clin Spine Surg 2020; 33:E33-E39. [PMID: 31996610 DOI: 10.1097/bsd.0000000000000939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A prospective cohort study. OBJECTIVE The objective of this study was to establish the correlation between radiographic spinopelvic parameters with objective biomechanical measures of function in patients with adult degenerative scoliosis (ADS). SUMMARY OF BACKGROUND DATA Gait and balance analyses can provide an objective measure of function. Patients with ADS demonstrate altered gait and balance patterns. Spinopelvic parameters are commonly used by clinicians to evaluate patients with ADS. However, to the best of our knowledge, no studies have examined the correlation between patients' radiographic spinopelvic parameters and biomechanical gait and balance parameters. PATIENT SAMPLE Forty-four patients with symptomatic ADS who have been deemed, appropriate surgical candidates. METHODS Radiographic spinopelvic parameters (CVA: central vertical axis, SVA: sagittal vertical axis, Cobb angle, PI-LL mismatch: pelvic incidence lumbar lordosis mismatch, and T1PA: T1 pelvic angle) were obtained the week before surgery. Then, gait and functional balance analyses (spatiotemporal parameters, center of mass, and head sway parameters) were performed on the same day. Correlations were determined between the radiographic spinopelvic parameters and biomechanical gait and balance parameters using Pearson product correlation. RESULTS Our results show that patients with higher Cobb angle and CVA tend to walk slower (r=-0.494, P<0.05). Furthermore, the higher the Cobb angle (r=0.396), CVA (r=0.412), SVA (r=0.440), and PI-LL mismatch (r=0.493), the more time ADS patients spend with their feet planted during single and double support phases of gait (P<0.05). In addition, patients with a higher Cobb angle, CVA, SVA, PI-LL mismatch, and T1PA, exhibited more trunk sway, increased lower extremity neuromuscular activity, and decreased spine neuromuscular activity (0.331<r<0.716, P<0.05). CONCLUSIONS This study demonstrated a moderate correlation between the biomechanical parameters as measured with gait and balance analyses and the radiographic spinopelvic parameters in ADS patients. With higher pathologic spinopelvic parameters, single support time, center of mass, and head sway and lower extremity neuromuscular activity were all increased. Quantified gait and balance analyses can be a useful tool to evaluate patient outcomes. Objective functional performance measures can help to improve the evaluation and understanding of the biomechanical effects of spinal disorders on locomotion.
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The Effect of Surgical Decompression on Functional Balance Testing in Patients With Cervical Spondylotic Myelopathy. Clin Spine Surg 2019; 32:369-376. [PMID: 31498275 DOI: 10.1097/bsd.0000000000000889] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A prospective cohort study. OBJECTIVE Quantify the extent of change in dynamic balance and stability in a group of patients with cervical spondylotic myelopathy (CSM) after cervical decompression surgery and to compare them with matched healthy controls. SUMMARY OF BACKGROUND DATA CSM is a naturally progressive degenerative condition that commonly results in loss of fine motor control in the hands and upper extremities and in gait imbalance. Whereas this was previously thought of as an irreversible condition, more recent studies are demonstrating postoperative improvements in balance and stability. MATERIALS AND METHODS Thirty subjects with symptomatic CSM and 25 matched asymptomatic controls between the ages of 45 and 75 years underwent functional balance testing using a 3D motion capture system to gather kinematic and spatiotemporal parameters. CSM subjects underwent testing 1 week before surgery and again 3 months postoperatively. RESULTS Patients with CSM exhibited markedly diminished balance as indicated by increased sway on a Romberg test and requiring significantly more time and a wider stance to complete tandem gait tests. The surgical intervention resulted in improved balance at the 3-month postoperative time point; however, kinematic and spatiotemporal parameters did not completely normalize to the levels observed in asymptomatic controls. CONCLUSIONS Human motion video capture can be used to robustly quantify balance parameters in the setting of CSM. Compared with healthy controls, such patients exhibited increased standing sway and poorer performance on a tandem gait task. The surgical intervention resulted in significant improvement in many of the measures of functional balance, but overall profiles had not completely returned to normal when measured 3 months after surgery. These data reinforce the importance of operative intervention in the treatment of symptomatic CSM with the goal of halting disease progress but the expectation that balance may actually improve postoperatively.
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The Change in Sway and Neuromuscular Activity in Adult Degenerative Scoliosis Patients Pre and Post Surgery Compared With Controls. Spine (Phila Pa 1976) 2019; 44:E899-E907. [PMID: 30830047 DOI: 10.1097/brs.0000000000003009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE The purpose of this study is to quantify the extent of change in sway associated with maintaining a balanced posture within the cone of economy (CoE), in a group of adult degenerative scoliosis (ADS) patients' pre and postsurgery and compare them to matched non-scoliotic controls. SUMMARY OF BACKGROUND DATA Patients with spinal deformities adopt a variety of postural changes in the spine, pelvis, and lower extremities in their effort to compensate for the anterior shift in the gravity line. ADS patients are known to exhibit an increased sway within their CoE. Greater sway expends more energy while standing when compared with healthy controls. Spinal alignment surgery has been shown to improve sagittal vertical axis and balance. METHODS Thirty-three ADS patients and performed a series of functional balance tests a week before and 3 months after surgery along with 20 non-scoliotic control. RESULTS ADS patients demonstrated more initial CoM (P = 0.001) and head (P = 0.011) displacements. Postoperatively ADS patients exhibited less CoM sway (P = 0.043) and head sway (P = 0.050), in comparison to their presurgery measures. Postsurgical ADS patients demonstrated more CoM (P = 0.002) and head (P = 0.012) displacements and increased muscle activity in comparison to non-scoliotic controls. CONCLUSION Surgical alignment reduced the amount of sway, reduced the center of mass displacement, and reduced spine and lower extremity energy expenditure in ADS' patients. In symptomatic preoperative ADS patients, sagittal sway increased along with greater lumbar spine and lower extremity neuromuscular activity in comparison to a non-scoliotic control. Although surgical alignment improved ADS functional parameters during a dynamic balance test, these parameters approached but did not fully achieve non-scoliotic control parameters when measured 3 months after surgery. LEVEL OF EVIDENCE 3.
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Lin IS, Lai DM, Ding JJ, Chien A, Cheng CH, Wang SF, Wang JL, Kuo CL, Hsu WL. Reweighting of the sensory inputs for postural control in patients with cervical spondylotic myelopathy after surgery. J Neuroeng Rehabil 2019; 16:96. [PMID: 31345240 PMCID: PMC6659243 DOI: 10.1186/s12984-019-0564-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 07/04/2019] [Indexed: 11/22/2022] Open
Abstract
Background Cervical spondylotic myelopathy (CSM) is a degenerative cervical disease in which the spinal cord is compressed. Patients with CSM experience balance disturbance because of impaired proprioception. The weighting of the sensory inputs for postural control in patients with CSM is unclear. Therefore, this study investigated the weighting of sensory systems in patients with CSM. Method Twenty-four individuals with CSM (CSM group) and 24 age-matched healthy adults (healthy control group) were analyzed in this observational study. The functional outcomes (modified Japanese Orthopaedic Association Scale [mJOA], Japanese Orthopaedic Association Cervical Myelopathy Questionnaire [JOACMEQ], Nurick scale) and static balance (eyes-open and eyes-closed conditions) were assessed for individuals with CSM before surgery, 3 and 6 months after surgery. Time-domain and time–frequency-domain variables of the center of pressure (COP) were analyzed to examine the weighting of the sensory systems. Results In the CSM group, lower extremity function of mJOA and Nurick scale significantly improved 3 and 6 months after surgery. Before surgery, the COP mean velocity and total energy were significantly higher in the CSM group than in the control group for both vision conditions. Compared with the control group, the CSM group exhibited lower energy content in the moderate-frequency band (i.e., proprioception) and higher energy content in the low-frequency band (i.e., cerebellar, vestibular, and visual systems) under the eyes-open condition. The COP mean velocity of the CSM group significantly decreased 3 months after surgery. The energy content in the low-frequency band (i.e., visual and vestibular systems) of the CSM group was closed to that of the control group 6 months after surgery under the eyes-open condition. Conclusion Before surgery, the patients with CSM may have had compensatory sensory weighting for postural control, with decreased weighting on proprioception and increased weighting on the other three sensory inputs. After surgery, the postural control of the patients with CSM improved, with decreased compensation for the proprioceptive system from the visual and vestibular inputs. However, the improvement remained insufficient because the patients with CSM still had lower weighting on proprioception than the healthy adults did. Therefore, patients with CSM may require balance training and posture education after surgery. Trial registration Trial Registration number: NCT03396055 Name of the registry: ClinicalTrials.gov Date of registration: January 10, 2018 - Retrospectively registered Date of enrolment of the first participant to the trial: October 19, 2015
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Affiliation(s)
- Iu-Shiuan Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Floor 3, No. 17, Xuzhou Rd., Zhongzheng District, Taipei, Taiwan.,Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Dar-Ming Lai
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Jian-Jiun Ding
- Graduate Institute of Communication Engineering, College of Electrical Engineering and Computer Science, National Taiwan University, Taipei, Taiwan
| | - Andy Chien
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
| | - Chih-Hsiu Cheng
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shwu-Fen Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Floor 3, No. 17, Xuzhou Rd., Zhongzheng District, Taipei, Taiwan.,Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Jaw-Lin Wang
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Chi-Lin Kuo
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Floor 3, No. 17, Xuzhou Rd., Zhongzheng District, Taipei, Taiwan. .,Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan.
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