The Berg balance scale for assessing dynamic stability and balance in the adult spinal deformity (ASD) population

Joseph L. Laratta, Steven D. Glassman, Abiola A. Atanda, John R. Dimar, Jeffrey L. Gum, Charles H. Crawford III, Kelly Bratcher, Leah Y. Carreon


Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.