ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2021
Cone of economy classification: evolution, concept of stability, severity level, and correlation to patient-reported outcome scores.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Markerless motion capture to quantify disability and functional performance in spine patients: a concurrent validity study bridging laboratory biomechanics and clinical practice.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Risk factors for PJK and DJF in operatively corrected adult patients with congenital hemivertebra.Spine deformity · 2026Article
- Clinical and biomechanical biomarkers of altered functional transitions in lumbar spinal stenosis with neurogenic claudication.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- T10-pelvic angle as a newly introduced sagittal parameter: a validation study in terms of pelvic tilt restoration, proximal junctional kyphosis, and clinical outcomes in adult spinal deformity surgery.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- The role of the lower extremity on patient's cone of economy: an innovative approach.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Applying Principles of Biomechanics of the Spine to Martial Arts: A Review on Balance of Stances in Goju-Ryu Karate-Do.Journal of functional morphology and kinesiology · 2025Review
- Therapeutic exercise following lumbar spine surgery: a narrative review.North American Spine Society journal · 2025Article
- Relationship between Health-Related Quality of Life and Sagittal Whole-Body Alignment, Standing Balance, and Skeletal Muscle Mass.Spine surgery and related research · 2025Article
- Alignment in motion: Fall risk in spine patients and the effect of vision, support surface, and adaptation on the cone of economy.North American Spine Society journal · 2024Article
- Sagittal spinopelvic alignment in ambulatory persons with cerebral palsy.Spine deformity · 2024Article
- Assessing the cone of economy in patients with spinal disease using only a force plate: an observational retrospective cohort study.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2021Observational
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5 authors.
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Abstract
STUDY
designA prospective cohort study
objectiveTo determine a classification system for cone of economy (CoE) measurements that defines clinically significant changes in altered balance and to assess if the CoE measurements directly impacts patients reported outcome measures (PROMs). Preoperative functional data is a crucial component of determining patient disability and prognosis. The CoE has been theorized to be the foundation of biomechanical changes that leads to increased energy expenditure and disability in spine patients. PROMs have been developed to quantify the level of debilitation in spine patients but have various limitations.
methodsA total of 423 symptomatic adult patients with spine pathology completed a series of PROMs preoperatively including VAS, ODI, Tampa Scale for Kinesiophobia (TSK), Fear and Avoidance Beliefs Questionnaire (FABQ), and Demoralization (DS). Functional balance was tested in this group using a full-body reflective marker set to measure head and center of mass (CoM) sway.
resultsPROMs scores were correlated with the magnitude of the CoE measurements. Patients were separated by the following proposed classification: CoM coronal sway > 1.5 cm, CoM sagittal sway > 3.0 cm, CoM total sway > 30.0 cm, head coronal sway > 3.0 cm, head sagittal sway > 6.0 cm, and head total sway > 60.0 cm. Significant differences were noted in the ODI (< 0.001), FABQ physical activity (< 0.001-0.009), DS (< 0.001-0.023), and TSK (< 0.001-0.032) across almost all planes of motion for both CoM and head sway. The ODI was most sensitive to the difference between groups across CoM and head sway planes with a mean ODI of 47.5-49.5 (p < 0.001) in the severe group versus 36.6-39.3 (p < 0.001) in the moderate group.
conclusionsBy classifying CoE measurements by the cutoffs proposed, clinically significant alterations in balance can be quantified. Furthermore, this study demonstrates that across spinal pathology, higher magnitude CoE and range of sway measurements correlate with worsening PROMs. The Haddas' CoE classification system in this study helps to identify patients that may benefit from surgery and guide their postoperative prognosis.
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