Texas Back Institute, 6020 West Parker Road, Plano, TX, 75093, USA.
UNT Health Science Center & John Peter Smith Hospital, Fort Worth, TX, USA.
Eur Spine J. 2021 Aug;30(8):2271-2282. doi: 10.1007/s00586-020-06678-z. Epub 2021 Jan 3.
A prospective cohort study OBJECTIVE: To determine a classification system for cone of economy (CoE) measurements that defines clinically significant changes in altered balance and to assess if the CoE measurements directly impacts patients reported outcome measures (PROMs). Preoperative functional data is a crucial component of determining patient disability and prognosis. The CoE has been theorized to be the foundation of biomechanical changes that leads to increased energy expenditure and disability in spine patients. PROMs have been developed to quantify the level of debilitation in spine patients but have various limitations.
A total of 423 symptomatic adult patients with spine pathology completed a series of PROMs preoperatively including VAS, ODI, Tampa Scale for Kinesiophobia (TSK), Fear and Avoidance Beliefs Questionnaire (FABQ), and Demoralization (DS). Functional balance was tested in this group using a full-body reflective marker set to measure head and center of mass (CoM) sway.
PROMs scores were correlated with the magnitude of the CoE measurements. Patients were separated by the following proposed classification: CoM coronal sway > 1.5 cm, CoM sagittal sway > 3.0 cm, CoM total sway > 30.0 cm, head coronal sway > 3.0 cm, head sagittal sway > 6.0 cm, and head total sway > 60.0 cm. Significant differences were noted in the ODI (< 0.001), FABQ physical activity (< 0.001-0.009), DS (< 0.001-0.023), and TSK (< 0.001-0.032) across almost all planes of motion for both CoM and head sway. The ODI was most sensitive to the difference between groups across CoM and head sway planes with a mean ODI of 47.5-49.5 (p < 0.001) in the severe group versus 36.6-39.3 (p < 0.001) in the moderate group.
By classifying CoE measurements by the cutoffs proposed, clinically significant alterations in balance can be quantified. Furthermore, this study demonstrates that across spinal pathology, higher magnitude CoE and range of sway measurements correlate with worsening PROMs. The Haddas' CoE classification system in this study helps to identify patients that may benefit from surgery and guide their postoperative prognosis.
前瞻性队列研究
确定一种用于圆锥经济（CoE）测量的分类系统，该系统可定义平衡改变的临床显著变化，并评估 CoE 测量是否直接影响患者报告的结果测量（PROMs）。术前功能数据是确定患者残疾和预后的关键组成部分。圆锥理论上被认为是导致脊柱患者能量消耗增加和残疾的生物力学变化的基础。PROMs 的开发是为了量化脊柱患者的衰弱程度，但存在各种局限性。
共有 423 名患有脊柱病理的成年症状患者完成了一系列术前 PROMs，包括 VAS、ODI、坦帕运动恐惧量表（Tampa Scale for Kinesiophobia，TSK）、恐惧和回避信念问卷（Fear and Avoidance Beliefs Questionnaire，FABQ）和沮丧（Demoralization，DS）。在这个组中，使用全身反射标记集来测量头部和质心（Center of Mass，CoM）摆动，以测试功能平衡。
PROMs 评分与 CoE 测量的幅度相关。根据以下提出的分类方法将患者分开：CoM 冠状摆动>1.5cm，CoM 矢状摆动>3.0cm，CoM 总摆动>30.0cm，头部冠状摆动>3.0cm，头部矢状摆动>6.0cm，头部总摆动>60.0cm。在 CoM 和头部摆动的几乎所有运动平面上，ODI（<0.001）、FABQ 体力活动（<0.001-0.009）、DS（<0.001-0.023）和 TSK（<0.001-0.032）均存在显著差异。ODI 在 CoM 和头部摆动平面上对组间差异最敏感，严重组的平均 ODI 为 47.5-49.5（p<0.001），中度组为 36.6-39.3（p<0.001）。
通过按提出的截止值对 CoE 测量进行分类，可以量化平衡的临床显著改变。此外，本研究表明，在整个脊柱病理中，更大幅度的 CoE 和摆动范围测量与 PROMs 的恶化相关。本研究中的 Haddas CoE 分类系统有助于识别可能受益于手术的患者，并指导其术后预后。
