Surgical decision making for cervical spondylotic myelopathy (CSM) relies on evaluation of symptoms and physical examination. The Romberg test is a clinical exam used to identify balance issues with CSM. However, the Romberg test has a subjective interpretation and has a binary (positive or negative) result.
T. Mkorombindo et al. did a prospective cross sectional observational comparative cohort from a single multi-surgeon spine center. They compared Force plate pressure readings during a standard Romberg test in patients with CSM to age-matched normal healthy volunteers. They found that - The Romberg test on a force plate may help diagnose and evaluate patients with CSM, guide patient management and potentially grade the severity of spinal pathology.
Patients with CSM requiring surgery and healthy normal volunteers were asked to perform the Romberg test while on a force plate (Diers Pedoscan System) measuring the center of pressure (CoP): standing up straight with arms extended for 30 seconds with eyes open, followed by 30 seconds with eyes closed. The change for total sway area, sway frequency and sway speed with eyes closed and eyes open were calculated and compared between patients with CSM and healthy volunteers.
A cohort of healthy volunteers was recruited from the clinic and asked to complete the Quantitative Romberg test. Healthy volunteers were excluded if they had a previous history of balance or neurological abnormality, previous spine injury, or lower extremity pathology.
The results of the study were -
• Thirty-four CSM patients were age-matched to 34 healthy volunteers.
• There was a larger change in quantitative Romberg measurements with eyes open versus eyes closed in CSM patients compared to normal volunteers for
maximum lateral movement (10.79 cm vs. 0.94 cm, p=.003),
maximum anterior-posterior movement (15.06 cm vs. 10.00 cm p=.201), total lateral CoP movement (89.82cm vs. 18.71cm, p=.007),
total AP CoP movement (154.68 cm vs. 87.47 cm, p=.601),
total CoP trace movement (199.79 cm vs. 88.44 cm, p=.014),
sway area (284.74 cm2 vs. 57.76 cm2 , p=.006), and
average speed (7.00 cm/s vs. 2.91 cm/s, p=.006).
The authors commented that - Further studies are needed to determine its utility in monitoring disease progression and measure treatment effectiveness.
Further reading:
Quantitative Romberg using a force plate: an objective measure for cervical myelopathy
Tino Mkorombindo,Steven D. Glassman, Jeffrey L. Gum, Morgan E. Brown, Christy L. Daniels, Leah Y. Carreon.
The Spine Journal 22 (2022) 535−541
https://doi.org/10.1016/j.spinee.2021.10.001
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