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. 2024 Jul 27:19:100532.
doi: 10.1016/j.xnsj.2024.100532. eCollection 2024 Sep.

Alignment in motion: Fall risk in spine patients and the effect of vision, support surface, and adaptation on the cone of economy

Ram Haddas  1 , Manjot Singh  2 , Paul Rubery  1 , Ashely Rogerson  1 , Andrew Megas  1 , Robert Molinari  1 , Gabriel Ramriez  1 , Tyler Schmidt  3 , Alan H Daniels  2 , Bassel G Diebo  2 , Varun Puvanesarajah  1
Affiliations

Alignment in motion: Fall risk in spine patients and the effect of vision, support surface, and adaptation on the cone of economy

Ram Haddas et al. N Am Spine Soc J. .

Abstract

Background: Several assessment tools have been developed to estimate a patient's likelihood risk of falling. None of these measures estimate the contributions of the visual, vestibular, and somatosensory systems to fall risk, especially in patients with degenerative lumbar spine disease.

Methods: Degenerative lumbar spine patients with radiculopathy (LD) and healthy subjects who were 35-70 years old without spine complaints were recruited. Patient reported outcome measures (PROMs) were collected prior to testing. Fall risk assessment was completed using Computer Dynamic Posturography (CDP), a computer-controlled balance machine that allows cone of economy (CoE) and cone of pressure (CoP) measurements. All patients completed Sensory Organization Tests (SOT) which include normal and perturbed stability, both with and without visual cues.

Results: In total, 43 spine patients and 12 healthy controls were included, with mean age 57.8 years, 39.5% females, and mean BMI of 29.3 kg/m2. Nearly all CoE and most CoP dimensions were found to be larger in LD patients compared to controls across nearly all subtests (p<.05), with the largest dimensions generally observed in the surrounding and support sway testing condition. In LD patients, ODI and PROMIS Pain Interference were negatively correlated with CoE and CoP measurements (p<.05).

Conclusions: In this prospective study, body sway was assessed as a function of CoE and CoP using the CDP system and was found to be elevated in spine patients, especially when they experienced increasing levels of visual and vestibular stimulation. The ability to identify the primary drivers of balance disorders is essential in spine patients and may be helpful in the development of a patient-specific treatment plan, which may in the future aid with fall-prevention initiatives.

Keywords: Center of pressure; Cone of economy; Degenerative lumbar spine disease; Fall risk; Somatosensory; Vestibular; Visual.

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Conflict of interest statement

One or more of the authors declare financial or professional relationships on ICMJE-NASSJ disclosure forms.

Figures

Fig 1
Fig. 1
Computerized dynamic posturography with sway surround and sway support.
Fig 2
Fig. 2
Computerized dynamic posturography 6 Sensory Organization Tests.
Fig 3
Fig. 3
Cone of economy and center of pressure measurements during the sensory organization tests for lumbar degenerative patients (Colors) and healthy control (Gray) in comparison to the baseline measurement (EOFS, eyes open with fixed support). ρ p<.05, Ϯ p<.01, ά p<.001(adjusted for multiple comparisons using Bonferroni's Correction). EOFS, eyes open with fixed support; ECFS, eyes closed with fixed support; EOSAFS, eyes open sway surround with fixed support; EOSS, eyes open with sway support, ECSS, eyes closed with sway support, EOSASS, eyes open sway surround with sway support.
See this image and copyright information in PMC

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