ABSTRACT
The Romberg sign helps demonstrate loss of postural control as a result of severely compromised proprioception. There is still no standard approach to applying the Romberg test in clinical neurology and the criteria for and interpretation of an abnormal result continue to be debated. The value of this sign and its adaptation when walking was evaluated. Detailed clinical examination of 50 consecutive patients of cervical myelopathy was performed prospectively. For the walking Romberg sign, patients were asked to walk 5 m with their eyes open. This was repeated with their eyes closed. Swaying, feeling of instability or inability to complete the walk with eyes closed was interpreted as a positive walking Romberg sign. This test was compared to common clinical signs to evaluate its relevance. Whilst the Hoffman's reflex (79%) was the most prevalent sign seen, the walking Romberg sign was actually present in 74.5% of the cases. The traditional Romberg test was positive in 17 cases and 16 of these had the walking Romberg positive as well. Another 21 patients had a positive walking Romberg test. Though not statistically significant, the mean 30 m walking times were slower in patients with traditional Romberg test than in those with positive walking Romberg test and fastest in those with neither of these tests positive. The combination of either Hoffman's reflex and/or walking Romberg was positive in 96% of patients. The walking Romberg sign is more useful than the traditional Romberg test as it shows evidence of a proprioceptive gait deficit in significantly more patients with cervical myelopathy than is found on conventional neurological examination. The combination of Hoffman's reflex and walking Romberg sign has a potential as useful screening tests to detect clinically significant cervical myelopathy.
Subject(s)
Gait Disorders, Neurologic/diagnosis , Somatosensory Disorders/diagnosis , Spinal Cord Compression/diagnosis , Walking/physiology , Diagnosis, Differential , Disability Evaluation , Feedback, Physiological/physiology , Gait Disorders, Neurologic/etiology , Gait Disorders, Neurologic/physiopathology , Humans , Middle Aged , Mobility Limitation , Neurologic Examination/methods , Postural Balance/physiology , Predictive Value of Tests , Prospective Studies , Reflex, Abnormal/physiology , Sensitivity and Specificity , Sensory Deprivation/physiology , Somatosensory Disorders/etiology , Somatosensory Disorders/physiopathology , Spinal Cord Compression/complications , Spinal Cord Compression/physiopathologyABSTRACT
The aim of this study was to determine predictors of functional outcome and survival in a retrospective cohort of spinal cord ependymomas treated at a single institution. Twenty-six patients who underwent treatment of spinal cord ependymoma at a single institution were retrospectively analysed. The clinicopathological features were reviewed and correlated with functional outcome (measured using the Frankel grade), recurrence (clinical or radiological), progression-free survival (PFS) and overall survival (OS). Seventy-nine percent of patients with complete excision had maintained or improved functional outcome, compared to 75% in the incomplete resection plus radiotherapy group. Patients with a good pre-operative Frankel grade tended to maintain their functional status, though this did not reach statistical significance (Fisher's Exact test, P = 0.090). Univariate analysis revealed that longer symptom duration prior to treatment was associated with poorer functional outcome (P = 0.006). Extent of resection and the use of adjuvant radiotherapy did not influence PFS or OS; however, early diagnosis and treatment are paramount in the management of spinal ependymoma if a good functional outcome is to be achieved.
