Balance control in adult spinal deformity: systematic review of the literature

BACKGROUND: Adult spinal deformity (ASD) encompasses X-ray diagnosed postural misalignments of the spine, such as scoliosis or kyphosis, that surpass known thresholds. ASD is associated with pain, disability, and falls, suggesting a relationship to balance deficits. The relationship between ASD and specific domains of balance control have not been fully explored. We aim to ascertain whether patients with ASD demonstrate balance deficits, and if so, which domains of balance are impaired. METHODS: A systematic review was conducted using five databases: PubMed, Medline, Scopus, Embase, and CINAHL. Articles were assessed for quality using the Joanna Briggs Institute critical appraisal tools. A posturography methodological quality assessment scale was used to rate the internal/external validity of studies incorporating force plate assessment. Inclusion criteria consisted of any balance assessment method used on the population of adults (18+) who had X-ray-diagnosed ASD. We followed PRISMA guidelines and registered this review in PROSPERO. FINDINGS: Twenty-two articles were included from 628 articles located across the databases. Study quality was determined to be generally high. Six different types of balance assessments were identified. Of 15 studies comparing ASD vs. control participants, the balance evaluation systems test (BESTest), cone of economy, sensory organization test and force plate-derived center-of-pressure metrics showed statistically different (poorer) scores for ASD participants. Alterations in postural responses and gait stability were not probed. INTERPRETATION: This review highlights that patients with ASD show impairments in balance control across a range of domains. Balance assessment in ASD can be used to identify targets for intervention.