Significance of Stabilometry for Assessing Postoperative Body Sway in Patients with Cervical Myelopathy

Abstract

Study DesignProspective study.PurposeTo examine the changes in body sway using stabilometry in patients who underwent cervical laminoplasty for cervical myelopathy.Overview of LiteratureAlthough the patients of cervical myelopathy complain body sway there are few report to examine body sway objectively.MethodsPatients who received treatment for cervical myelopathy between October 2010 and February 2013 were included. Twenty-one patients underwent cervical laminoplasty (myelopathy group). Body sway was assessed using stabilometry, wherein patients stood on a stabilometer with their eyes closed for 30 seconds. The Romberg ratio, outer peripheral area (OPA) with eyes closed (cm2), and total locus length per unit area (L/A) with eyes closed (/cm) were examined. Examinations were performed preoperatively (at baseline) and at 8 weeks postoperatively. Examination results of patients in the myelopathy group were compared with those of 17 healthy individuals (control group). Clinical symptoms were evaluated using the Japanese Orthopaedic Association scale score (JOA score) and the timed up and go (TUG) test.ResultsIn the myelopathy and control groups, the mean baseline Romberg ratio, OPA, and L/A were 2.3±1.2, 8.9±5.5 cm2, and 14.2±5.3/cm and 1.4±1.0, 4.3±2.8 cm2, and 23.7±10.1/cm, respectively. Eight weeks after laminoplasty, only L/A showed significant improvement from baseline in the myelopathy group (23.2±10.1 to 16.8±7.9; p=0.03). The Romberg ratio and OPA showed improvement in the myelopathy group, but the changes were not statistically significant. JOA scores and TUG test results in this group significantly improved from baseline to 8 weeks after laminoplasty (12.7 to 13.4 and 10.8 to 8.0 seconds, respectively; both p<0.05).ConclusionsL/A is a useful parameter for measuring body sway to assess the recovery of body sway after laminoplasty.

Assessment of standing balance in normal versus cervical spondylotic myelopathy patients

“…This may be a direct effect of cord compression over the dorsal columns, which transmit fibers for proprioception and joint position sense [ [1] , [2] , [3] , 17 ]. Poor static balance control and increase in body sway results from this compression [ 3 , 6 , 17 ]. Testing proprioceptive ability in patients with cervical myelopathy as a function of knee position sense has been first described by Takayama et al.…”

“…When combined with temporal measurements, the speed and frequency of balance correction can be obtained as well. Emphasis was placed on the total sway area, and the average speed and frequency of correction since it correlates directly to body sway and its response to balance control [ 3 , 6 , 10 ].…”

“…Loss of balance control is a common clinical symptom in patients with cervical myelopathy, manifesting as difficulty in maintaining posture and normal gait [1][2][3][4][5][6] . Balance is achieved through central nervous system synthesis via three main afferents: (1) proprioception and joint positioning, (2) visual input and (3) vestibulocochlear systems.…”

“…Only a few studies have objectively measured balance control mechanisms in myelopathic patients [ 3 , 6 , 9 ]. The Romberg test evaluates the somatosensory, visual and vestibulocochlear systems for balance control by testing if there is an increased sway or loss of balance when the patient stands still with eyes open and eyes closed [10] , [11] , [12] .…”

Perturbation-Based Balance Training in Postoperative Individuals With Degenerative Cervical Myelopathy

“…In addition, delayed neuromuscular recruitment and postural unsteadiness under perturbation were reported in individuals with DCM (Nardone et al, 2008). Although an improvement in balance have been reported after surgery (Tanishima et al, 2017), whether balance deficits associated with DCM can be fully reversed postoperatively remain inconclusive due to the lack of comparison with healthy adults.…”