The Impact of Cervical Sagittal Slope on Postural Oscillation and Balance

Yıl 2022, Cilt: 17 Sayı: 1, 101 - 106, 21.03.2022

Hilal Akay , Adnan Demirel , Ejder Berk , Vedat Nacitarhan Murat Baykara

https://doi.org/10.17517/ksutfd.874578

Öz

Aim: Static balance and postural oscillation can be affected by different diseases. The aim of this study was to investigate balance disorders with clinical tests and stabilometric measurements in individuals with cervical lordosis loss or cervical kyphosis and to compare the balance state with cervical lordosis individuals.
Material and method: In our study, 102 patients, with cervical lateral radiographs and met criteria for inclusion into the study, who applied to the physical medicine and rehabilitation polyclinic within the last 6 months were evaluated. Patients were divided into 4 groups according to the cervical sagittal slope angles calculated based on the Cobb method. Stabilometric measurements of the patients were performed in 8 different positions (Table 1). In addition, the berg balance scale (BBS) and the activity-specific balance confidence scale (ABC) scores were calculated and the timed up and go test (TUG), the four square step test (FSST) and the functional reach test (FRT) were performed. Statistical significance was accepted as p <0,05 in all statistical evaluations.
Findings: Statistically significant differences were found in the head neutral position (NC) mediolateral oscillation rate, NC mediolateral total oscillation amount, NC anteroposterior oscillation rate, NC anteroposterior total oscillation amount, NC vectorial maximum oscillation amount, NC vectorial total oscillation amount, head in right rotation (HR) anteroposterior maximum oscillation amount, HR anteroposterior oscillation rate, HR anteroposterior total oscillation amount and eyes closed on sponge, head in neutral position (PC) anteroposterior maximum oscillation amount from the stabilometric measurements of the patients participating in the study. There was no significant difference between the groups in terms of BBS score, ABC score, TUG and FSST score and FRT.
Conclusion: According to the results of this study, while there were significant differences in terms of some posturographic parameters among the patients grouped according to the cervical sagittal slope angles, there was no difference between the groups in terms of some parameters. This result suggests that cervical sagittal slope gradually affects some components of postural performance from lordosis to kyphosis, however, not all components were affected by that.

Anahtar Kelimeler

Balance, Servical sagittal slpoe, Stabilometry

Servikal Sagital Eğimin Postüral Salınım ve Denge Üzerine Etkisi

Öz

Amaç: Statik denge ve postüral salınım farklı hastalıklardan etkilenebilir. Bu çalışmanın amacı; servikal lordoz kaybı ya da servikal kifoz olan bireylerde klinik testler ve stabilometrik ölçümler ile denge bozukluğunu araştırmak ve servikal lordozu olan bireylerle denge durumunu karşılaştırmaktır.
Gereç ve Yöntem: Çalışmamızda son 6 ay içinde Fiziksel Tıp ve Rehabilitasyon polikliniğine başvuran, servikal lateral grafisi çekilmiş olan ve araştırmaya alınma kriterlerine uyan 102 hasta değerlendirildi. Hastalar Cobb metoduna göre hesaplanan servikal sagittal eğim açılarına göre 4 gruba ayrıldı. Hastaların 8 farklı pozisyonda stabilometrik ölçümleri yapıldı. Ayrıca berg denge skalası (BDS) ve aktiviteye özgü denge güvenlik skalası (AÖDGS) skorları hesaplanıp, zamanlı ayağa kalkma yürüme testi (ZAKYT), dört kare adımlama testi (DKAT) ve fonksiyonel uzanma testi (FUT) yapıldı. İstatistiksel tüm değerlendirmelerde anlamlılık düzeyi p<0,05 olarak kabul edildi.
Bulgular: Çalışmaya katılan hastaların stabilometrik ölçümlerinden NC mediolateral salınım hızı, NC mediolateral toplam salınım miktarı, NC anteroposterior salınım hızı, NC anteroposterior toplam salınım miktarı, NC vektöriyel maximum salınım miktarı, NC vektöriyel toplam salınım miktarı, HR anteroposterior maksimum salınım miktarı, HR anteroposterior salınım hızı, HR anteroposterior toplam salınım miktarı ve PC anteroposterior maksimum salınım miktarı bakımından istatistiksel olarak anlamlı fark saptandı (p<0.05)(Tablo 1). BDT skoru, AÖDGS skoru, ZAKYT ve DKAT süresi ve FUT açısından ise gruplar arasında anlamlı fark yoktu.
Sonuç: Bu çalışmanın sonuçlarına göre servikal sagittal eğim açılarına göre gruplandırılan hastalar arasında bazı postürografik parametreler açısından anlamlı farklar tespit edilirken, bazıları açısından gruplar arasında fark bulunamamıştır. Bu sonuç servikal sagittal eğimin lordozdan kifoza doğru gittikçe postüral performansın bazı komponentlerini olumsuz yönde etkilediğini ancak tüm komponentlerini etkilemediğini düşündürmektedir.

Anahtar Kelimeler

Denge, Servikal sajittal eğim, Stabilometri

Kaynakça

• 1. Scheer, Justin K., et al. "Cervical spine alignment, sagittal deformity, and clinical implications: a review." Journal of Neurosurgery: Spine 19.2 (2013): 141-159. 2. Grob, D., H. Frauenfelder, and A. Mannion, The association between cervical spine curvature and neck pain. European Spine Journal, 2007. 16(5): p. 669-678. 3. Breig A, Turnbull I, Hassler O. Effects of mechanical stresses on the spinal cord in cervical spondylosis. A study on fresh cadaver material. J Neurosurg 1966;25:45-56.
• 4. Hülse M, Hölzl M. Vestibulospinal reactions in cervicogenic disequilibrium. Cervicogenic imbalance. HNO 2000;48:295-301.
• 5. Dehner C, Heym B, Maier D, Sander S, Arand M, Elbel M, et al. Postural control deficit in acute QTF grade II whiplash injuries. Gait Posture 2008;28:113-9.
• 6. Storaci R, Manelli A, Schiavone N, Mangia L, Prigione G, Sangiorgi S. Whiplash injury and oculomotor dysfunctions: clinical-posturographic correlations. Eur Spine J 2006;15:1811-6.
• 7. Ryan GMS, Cope S. Cervical vertigo. Lancet 1955;1355-8. [Abstract] [PDF].
• 8. Rix GD, Bagust J. Cervicocephalic kinesthetic sensibility in patients with chronic, nontraumatic cervical spine pain. Arch Phys Med Rehabil 2001;82:911-19.
• 9. Humphreys BK. Cervical outcome measures: testing for postural stability and balance. J Manipulative Physiol Ther 2008;31:540-46.
• 10. Balaban Ö, Nacır B, Erdem HR, Karagöz A. The Evaluation of the Balance Function. JPMRS 2009;12:133-9.
• 11. Liaw MY, Chen CL, Pei YC, Leong CP, Lau YC. Comparison of the static and dynamic balance performance in young, middle-aged, and elderly healthy people. Chang Gung Med J 2009;32:297-304.
• 12. Dıraçoğlu D, Cihan C, İşsever H, Aydın R. Servikal radikülopatili hastalarda postüral performans. Turk J Phys Med Rehab 2009;55:153-7.
• 13. Karnath HO. Subjective body orientation in neglect and the interactive contribution of neck muscle proprioception and vestibular stimulation. Brain 1994;117:1001-12.
• 14. Dietrich M, Pollmann W, Pfaffenrath V. Cervicogenic headache: Electronystagmography, perception of verticality and posturography in patients before and after C2-blockade. Cephalalgia 1993;13:285–8.
• 15. Colledge NR, Barr-Hamilton RM, Lewis SJ, Sellar RJ, Wilson JA. Evaluation of investigations to diagnose the cause of dizziness in elderly people: a community based controlled study. BMJ 1996 Sep 28;313:788-92.
• 16. Shereen A, Machaly & Mohammed K, Senna & Ahmed G. Sadek. Vertigo is associated with advanced degenerative changes in patients with cervical spondylosis. Clin Rheumatol 2011;30:1527–34.
• 17. Bauer CM, Gröger I, Rupprecht R, Tibesku CO, Gaßmann KG. Reliability of static postürography in elderly persons. Z Gerontol Geriatr 2010;43:245–8.
• 18. Kaparov A. Multipl Sklerozlu Olgularda Dengenin Bilgisayarlı Postürografi Cihazı Ve Klinik Testlerle Değerlendirilmesi. Uzmanlık tezi, İ. Ü. Cerrahpaşa Tıp Fakültesi, İstanbul, 2012.
• 19. Günendi Z, Demirsoy N. Postmenopozal osteoporozlu kadınlarda postural stabilitenin klinik ve bilgisayarlı stabilometrik değerlendirmesi. Türk Fiz Tıp Rehab Derg 2007;53:130-3.
• 20. Palmgren PJ, Andreasson D, Eriksson M, Hägglund A. Cervicocephalic kinesthetic sensibility and postural balance in patients with nontraumatic chronic neck pain--a pilot study. Chiropr Osteopat 2009;17:6.
• 21. Karlberg M, Persson L, Magnusson M. Impaired postural control in patients with cervico-brachial pain. Acta Otolaryngol 1995;520:440-2.