Laratta Joseph L, Glassman Steven D, Atanda Abiola A, Dimar John R, Gum Jeffrey L, Crawford Charles H, Bratcher Kelly, Carreon Leah Y
Norton Leatherman Spine Center, Louisville, KY, USA.
Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
J Spine Surg. 2019 Dec;5(4):451-456. doi: 10.21037/jss.2019.09.15.
Adult spinal deformity (ASD) is a prevalent condition in individuals over the age of 65; leading to impaired standing balance and abnormal gait patterns. This functional impairment may be due to the fixed sagittal or coronal malalignment; associated spinal stenosis or deconditioning. The Berg balance scale (BBS) was developed to measure balance by assessing the performance of functional tasks. The purpose of this study is to determine if BBS is a useful metric for evaluating functional status in ASD patients.
ASD patients who required fusion from the thoracic spine to the pelvis from 2014 to 2016 were enrolled and asked to complete the BBS prior to and six months after surgery. BBS were obtained by a certified physical therapist. Standard demographic; radiographic and surgical data were collected. The Oswestry disability index (ODI), EuroQOL-5D and numeric rating scales (0 to 10) for back and leg pain were assessed at baseline and post-intervention.
Of 21 patients enrolled; 19 completed pre- and post-surgery BBS. The mean age was 59.8±13.3 years with 14 females. There was a statistically significant improvement in all outcome scores and radiographic parameters after surgery; but no difference in BBS. Only one patient had a BBS score low enough to be considered a medium fall risk. There was no difference in the pre-op BBS scores in the four patients that had revision surgery compared to those that did not.
In this small pilot study; BBS did not appear to be associated with measures of clinical and radiographic improvement in ASD patients. The test was also potentially problematic in that it has a ceiling effect and required significant time with a trained physical therapist for administration. Continued effort to identify a viable measure of balance dysfunction in ASD patients is warranted.
成人脊柱畸形（ASD）在65岁以上人群中较为普遍，会导致站立平衡受损和步态异常。这种功能障碍可能是由于固定的矢状面或冠状面排列不齐、相关的椎管狭窄或身体机能下降所致。伯格平衡量表（BBS）旨在通过评估功能性任务的完成情况来测量平衡能力。本研究的目的是确定BBS是否是评估ASD患者功能状态的有用指标。
纳入2014年至2016年需要从胸椎至骨盆进行融合手术的ASD患者，并要求他们在手术前和术后六个月完成BBS测试。BBS测试由一名认证的物理治疗师进行。收集标准的人口统计学、影像学和手术数据。在基线和干预后评估奥斯威斯功能障碍指数（ODI）、欧洲五维健康量表（EuroQOL-5D）以及背部和腿部疼痛的数字评分量表（0至10）。
在纳入的21名患者中，19名完成了手术前后的BBS测试。平均年龄为59.8±13.3岁，其中14名女性。术后所有结局评分和影像学参数均有统计学意义上的显著改善，但BBS测试结果无差异。只有一名患者的BBS评分低到足以被认为有中度跌倒风险。与未进行翻修手术的患者相比，进行翻修手术的四名患者术前BBS评分无差异。
在这项小型试点研究中，BBS似乎与ASD患者的临床和影像学改善指标无关。该测试还可能存在问题，因为它有天花板效应，并且需要经过培训的物理治疗师花费大量时间来进行测试。有必要继续努力寻找一种可行的方法来测量ASD患者的平衡功能障碍。
