P35. Quantitative Romberg using a force plate: an objective measure for cervical myelopathy

Abstract

BACKGROUND CONTEXT Surgical decision making for cervical spondylotic myelopathy (CSM) relies on symptoms and physical examination. The Romberg test is a clinical exam used to identify balance issues with CSM, but has subjective interpretation and has a binary (positive or negative) result. Using a force plate, the area, frequency and speed of sway with eyes open and eyes closed can be quantified. This objective measurement has the potential for earlier intervention and/or to monitor treatment progress. Additionally, this measurement tool is more practical than a formal gait analysis in the clinical setting. PURPOSE To determine if a quantitative Romberg test can provide an objective measure of poor standing balance due to myelopathy. STUDY DESIGN/SETTING Age-matched prospective observational comparative cohort. PATIENT SAMPLE Patients with CSM requiring surgery and healthy normal volunteers. OUTCOME MEASURES Total sway area (TSA), sway frequency and sway speed. METHODS Patients with CSM requiring surgery and healthy normal volunteers were asked to perform the Romberg test while on a force plate measuring the center of pressure: standing up straight with arms extended for 30 seconds with eyes open, followed by 30 seconds with eyes closed. The change in total sway area (TSA), sway frequency and sway speed with eyes closed and eyes open were calculated. RESULTS A total of 27 of 48 CSM patients were age-matched to 27 healthy volunteers with a mean age of 54 years. The change in TSA (211.5mm2), frequency (365.4/s) and speed (7.0m/s) was statistically greater in the CSM group compared to normal TSA (87.8mm2, p=0.005), frequency (62.1/s, p=0.008) and speed (4.2m/s, p=0.085). CONCLUSIONS Poor standing balance can be quantified in patients with CSM. The Romberg test on a force plate may help diagnose and evaluate CSM. Further studies are needed to determine its utility to measure treatment effectiveness. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.