Medical Director Norton Leatherman Spine Center Louisville, Kentucky, United States
Introduction: Cervical Spondylotic Myelopathy (CSM) is characterized by balance deficiencies produced by impaired proprioception. Evaluation is subjective and binary physical exam findings that lack precision without the ability to assess postoperative outcome improvement. The purpose of this study was to evaluate the utility of quantitative Romberg measurements as a pre- and post-op outcome measure.
Methods: CSM patients were prospectively enrolled to undergo pre- and postoperative Romberg tests on a force plate to record center of pressure (COP) motion for 30 seconds with eyes open followed by eyes closed. Revision cases were excluded. Kinematics of COP movement parameters were compared between pre- and postop state for each patient.
Results: Nineteen CSM patients were enrolled and completed pre/post testing. Mean age was 59.8 years with 10 (53%) males, 5 (26%) smokers. Mean number of surgical levels was 2.53. The minimum mean follow up was six months. There was a statistically significant improvement in eyes closed postop compared to pre-op for total COP motion (590.74cm2 vs 447.05cm2, p=0.036), average sway speed (19.58cm/s vs 15.05cm/s, p=0.009) and total lateral COP motion (310.95cm2 vs 229.89cm2, p=0.044). There was statistically significant improvements in NDI (42.64 vs 29.78, p< 0.001), neck pain (5.35 vs 2.88, p=0.001 and arm pain scores (4.50 vs 2.38, p=0.041).
Conclusion : CSM findings on Romberg quantitative testing significantly improves postoperatively in patients with CSM. These findings support this testing as representative of proprioceptive balance deficiencies seen in CSM. Quantitative Romberg may be used as an objective measure of clinical outcome and assist in stratification of surgical intervention timing and technique.
How to Improve Patient Care: Quantitative Romberg testing on a force plate demonstrates significant improvement after surgery which may serve as an objective quantification of outcomes and guide intervention timing or technique.
