Quantitative Romberg on a Force Plate: Objective Assessment Before and After Surgery for Cervical Spondylotic Myelopathy.

STUDY DESIGN: Longitudinal Observational Cohort. OBJECTIVES: The purpose of this study was to evaluate the utility of Quantitative Romberg measurements as pre- and post-op balance outcome measures. SUMMARY OF BACKGROUND DATA: Cervical Spondylotic Myelopathy (CSM) is characterized by balance deficiencies produced by impaired proprioception. Evaluation is subjective and binary physical exam findings lack the precision to assess postoperative outcome improvement. METHODS: CSM patients were prospectively enrolled to undergo pre- and postoperative Quantitative 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 postoperative state for each patient. RESULTS: Twenty-seven CSM patients were enrolled and completed both pre/post testing. Mean age was 60.0 years with 13 (48%) males, 9 (33%) smokers. Mean number of surgical levels was 2.48. The minimum mean follow-up was six months. There was a statistically significant improvement in eyes closed after surgery compared to pre-operative for total COP motion (523.44 cm vs. 387.00 cm, P<0.001), average sway speed (17.41 cm/s vs. 13.00 cm/s, P<0.001) and total lateral COP motion (253.44 cm vs. 186.70 cm, P<0.001). There was no statistically significant improvement in mJOA (13.29 vs. 14.29, P=0.28). CONCLUSION: CSM balance findings on Quantitative Romberg 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 interventions, surgery timing and technique.