Improving surgical decision-making for cervical spine patients

The quantified Romberg test provides measurable evidence of stability or deterioration and improves surgical decision-making.

Difficulty with standing balance is a frequent clinical issue with multiple possible etiologies. It may be seen with normal aging or common pathologies such as diabetic neuropathy. In patients with cervical degenerative disease, progressive standing and gait imbalance can be an indication of cervical spinal cord dysfunction, termed cervical spondylotic myelopathy (CSM). As opposed to most cervical degenerative conditions, which are managed electively, CSM may require more aggressive treatment secondary to the risk of permanent spinal cord injury.

Using the quantified Romberg test to measure progression

Surgical decision-making in CSM is typically dependent on physical exam findings, with a history of stepwise deterioration suggesting the potential need for surgery. The Romberg test is a standard clinical measure of standing balance. Patients are asked to stand independently with their eyes open and then with their eyes closed. Patients with impaired spinal cord function often have increased difficulty with the loss of visual cue. This is one of the standard physical exam findings for CSM, however, it historically has been graded as positive or negative, making subtle changes difficult to document. Research at Norton Leatherman Spine over the past several years has led to the development of a quantified Romberg test through which progressive deterioration can be monitored more effectively.

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Quantified Romberg is obtained by using a force plate to accurately measure standing imbalance during Romberg testing. In an initial set of studies, the Norton Leatherman Spine research team, led by me and Leah Carreon, M.D., demonstrated differences in quantified Romberg findings between patients with CSM and those without a spine condition, and then as compared with age-matched normal individuals. Subsequently, the team demonstrated documented improvement in quantified Romberg testing with surgical intervention. Present studies are focusing on the role of wearable sensors to generate quantified Romberg data without the need for a force plate in the office.

From the patient’s perspective, it is difficult to decide when to have surgery to prevent a potentially catastrophic issue that has not yet occurred. Cervical MRI findings alone are only one element of risk assessment, and it may be difficult to determine whether they represent a new development or a long-standing abnormality. Adding specific, measurable evidence of clinical stability or deterioration is extremely helpful to both the physician and patient, facilitating more robust shared decision-making regarding the need for surgical treatment. In this instance, the quantified Romberg test improves surgical decision-making for patients with cervical myelopathy.

Dr. Glassman is an orthopedic spine surgeon and medical director of Norton Leatherman Spine. In 2024, the American Association of Neurological Surgeons named Dr. Glassman an honorary member. He is the first person to earn the award since 2007. The honor recognized him for his work to pave collaboration among orthopedic surgeons and neurosurgeons.

Norton Leatherman Spine research

This is one of many examples of relevant transitional clinical research at Norton Leatherman Spine. As a leading national spine center, Norton Leatherman Spine has focused research efforts on studies with the potential to impact clinical practice. Learn more about our clinical research at

Current clinical trials and studies at Norton Leatherman Spine

Recently published research from Norton Leatherman Spine physicians

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