Functional Balance Testing, Gait Analysis Trump PROMS after Degenerative Lumbar Spondylolisthesis Surgery

by Elizabeth Hofheinz, M.P.H., M.Ed.

If life is all about balance, then a team of innovative researchers from the Texas Back Institute (TBI) in Plano, Texas are helping people stay on target. The researchers have used quantitative dynamic testing to determine the effect of lumbar decompression and fusion on the cone of economy (CoE) in patients with degenerative lumbar spondylolisthesis (DLS).

The team, which included Isador Lieberman, M.D., M.B.A., an orthopedic spine surgeon at TBI, examined 45 patients with DLS who undertook functional balance tests one week preoperatively and three months postoperatively; they were compared to 28 controls.

The study, “The Effect of Surgical Decompression and Fusion on Functional Balance in Patients With Degenerative Lumbar Spondylolisthesis,” was published in the July 15, 2020 edition of Spine.

Dr. Lieberman told OSN, “We have been increasingly reliant on PROMs to assess the improvement in patient outcome after intervention, despite the perception that PROMs are objective they are not, the only true objective measure of function is a dynamic gait lab analysis.”

The researchers looked at range of sway (RoS) and total sway for the center of mass (CoM) and head in the sagittal, coronal, and axial planes. They also examined leg and back Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Fear/Avoidance Behavior Questionnaire (FABQ), Tampa Scale of Kinesophobia (TSK), and Demoralization scale.

Asked if there has been much work done in this area to date, Dr. Lieberman told OSN, “No, TBI is leading the way in defining the best method to measure objective function after intervention, we established the TBI Gait Lab over five years ago and now have an in-depth experience to draw conclusion from regarding the benefits of our surgical interventions.”

The authors wrote, “RoS for the CoM and head decreased in all planes postoperatively. Reductions in CoM and head total sway were also observed after surgery. Furthermore, patients with DLS reported strong improvements in VAS low back, VAS leg, ODI, FABQ Physical, TSK and demoralization with surgical intervention. Although total sway was reduced after surgery, it did not return to the level of normal controls as demonstrated with more total sway of their CoM and head as well as more sagittal head RoS.”

“In the setting of progressive symptomatic degenerative spondylolisthesis surgical intervention improves patient function,” said Dr. Lieberman to OSN. “While PROMs are important, functional balance testing and gait analysis are more objective.”