Spine Journal - 2026-06-24 - Journal Article
Quantifying Postural Recovery After Lumbar Decompression: Cone of Economy Biomarkers of Balance Effort and Stability in Patients with Radiculopathy and Neurogenic Claudication.
Haddas R, Romiyo P, Shu Y, Rubery P, Rogerson A, Puvanesarajah V
Topics
Key Takeaway
Lumbar decompression reduced mediolateral center-of-pressure sway by 24% (2.24 to 1.70 cm) and improved ODI by 16.8 points at 3 months, with Cone of Economy metrics capturing postural recovery not reflected by PROMs alone.
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Summary
This study asked whether high-resolution 3D motion capture Cone of Economy metrics could objectively quantify postural recovery after lumbar decompression for stenosis. Thirty-six patients underwent standardized balance assessment one week preoperatively and three months postoperatively using a 41-marker system synchronized to dual force plates, with mixed-effects models correcting for multiple comparisons. Mediolateral CoP sway, head coronal sway, CoM sway, total head sway path area, and compensatory cervical, pelvic, and hip kinematics all improved significantly, alongside ODI improvement of 16.8 points and TSK reduction of 7.1 points.
Key Limitation
Three-month follow-up is insufficient to determine whether postural improvements are durable or whether patients with residual sway deficits are at elevated long-term fall risk.
Original Abstract
BACKGROUND CONTEXT
Degenerative lumbar spine pathology manifesting as radiculopathy and neurogenic claudication often leads to impaired postural stability, compensatory movement strategies, and increased fall risk. Conventional clinical assessments and patient-reported outcomes inadequately characterize dynamic balance dysfunction and postural control deficits that persist after surgical intervention.
PURPOSE
To objectively quantify changes in postural stability, balance effort, and Cone of Economy (CoE) control following lumbar decompression surgery in patients with radiculopathy and neurogenic claudication using high-resolution three-dimensional motion analysis.
STUDY DESIGN/SETTING
Prospective, single-center cohort study.
PATIENT SAMPLE
Thirty-six adults (mean age 70.1 ± 11.4 years) with symptomatic degenerative lumbar spinal stenosis undergoing open decompression surgery.
OUTCOME MEASURES
Postural sway and stability metrics, including CoE dimensions, center-of-pressure (CoP) and center-of-mass (CoM) excursion, sway path and velocity, phase-plane stability, frequency-domain characteristics, and joint-level compensatory excursions, along with patient-reported outcomes (Oswestry Disability Index, PROMIS, Tampa Scale of Kinesiophobia).
METHODS
Participants completed standardized three-dimensional balance assessments one week before and three months after decompression using a 41-marker motion capture system synchronized to dual force plates. Mixed-effects models tested pre- to postoperative changes, accounting for age, BMI, and repeated measures with false discovery rate correction for multiple comparisons.
RESULTS
Lumbar decompression was associated with significant improvements in mediolateral postural control. Center-of-pressure mediolateral sway decreased from 2.24 ± 0.92 cm to 1.70 ± 0.69 cm (p = 0.007), head coronal sway from 3.29 ± 1.11 cm to 2.38 ± 0.87 cm (p = 0.001), and CoM coronal sway from 1.85 ± 0.74 cm to 1.40 ± 0.63 cm (p = 0.009). Expanded balance metrics demonstrated reductions in total head sway path area (9.55 ± 3.12 → 6.47 ± 2.41; p = 0.001), improved phase-plane stability (p < 0.001), and decreased low- and mid-frequency sway power (p ≤ 0.014). Compensatory strategies at the cervical spine, lumbar coronal motion, pelvis, and hips were significantly reduced postoperatively, while knee and ankle kinematics were maintained. Patient-reported disability and pain interference improved (ODI -16.8, PROMIS Pain -8.2; both p < 0.001), with significant reductions in kinesiophobia (TSK -7.1; p < 0.001).
CONCLUSIONS
Lumbar decompression was associated with quantifiable improvements in postural stability and balance efficiency. High-resolution sway and CoE metrics provide objective, mechanistic biomarkers of functional recovery that complement traditional patient-reported outcomes. These findings support the potential role of dynamic balance assessment in postoperative evaluation and rehabilitation planning to reduce fall risk and optimize functional outcomes after lumbar spinal decompression.