Visual Verticality Perception in Spinal Diseases: A Systematic Review and Meta-Analysis

Abstract

Patients diagnosed with traumatic or non-traumatic spinal pain and idiopathic scoliosis frequently suffer from imbalance. The evaluation of the perception of verticality by means of visual tests emerges as a quick and easy tool for clinical management of the balance disorders. Several studies have assessed the visual perception of verticality in spinal diseases obtaining controversial results. The aim of our study is to analyze the perception of visual verticality in subjects with several spinal diseases in comparison with healthy subjects. A meta-analysis was carried out. PubMed MEDLINE, Scopus, WoS, CINAHL, and SciELO databases were searched until January 2020. The standardized mean difference (SMD) was calculated to analyze differences between patients and healthy controls. Fifteen studies with a total of 2052 patients were included. In comparison with healthy subjects, a misperception of verticality was found in patients with spinal pain when the perception of the verticality was assessed with the rod and frame test (SMD = 0.339; 95% confidence interval (CI) = 0.181, 0.497; p < 0.001). It seems that the perception of visual verticality is not altered in patients with idiopathic scoliosis (p = 0.294). The present meta-analysis shows a misperception of visual verticality only in patients with spinal pain.

Misperception of Visual Verticality in Patients with Primary Headache Disorders: A Systematic Review with Meta-Analysis

“…In the case of TTH, excitability of deep nociceptors of upper cervical structures triggers headache attacks, contributing to the sensitization process responsible for TTH chronification. Recently, the first meta-analysis has been published that investigates the alteration of the visual perception of verticality in patients with spinal diseases [ 66 ]. The results of this study confirm an impairment of the VV perception in spinal pain, highlighting the importance of proprioceptive inputs in order to generate a perception of VV in patients with spinal pain [ 66 ].…”

“…Recently, the first meta-analysis has been published that investigates the alteration of the visual perception of verticality in patients with spinal diseases [ 66 ]. The results of this study confirm an impairment of the VV perception in spinal pain, highlighting the importance of proprioceptive inputs in order to generate a perception of VV in patients with spinal pain [ 66 ]. The degree of importance of upper cervical structures in both PHD physiopathology and the formation of a three-dimensional central pattern of verticality leads us to conclude that misperception of verticality in patients with headache may be motivated by upper cervical dysfunctions.…”

Misperception of body verticality in neurological disorders: A systematic review and meta‐analysis

“…Although numerous studies have been performed to determine the visual contribution to verticality patterns in subjects with neurological (Molina et al., 2019 ) or spinal diseases (Obrero‐Gaitán et al., 2020 ) a small but emerging interest in the assessment of the contribution of vestibular and somatosensory systems to verticality construction in patients with neurological pathology is occurring. Following this interesting research, the present systematic review and meta‐analysis has set as the primary objective to detect, collect, and perform a quantitative synthesis of the best available evidence regarding the vestibular and somatosensory contribution to the verticality central pattern in patients with stroke and other neurological problems using SPV assessment.…”

New Mobile Device to Measure Verticality Perception: Results in Young Subjects with Headaches

“…It is believed that SVV tests estimate the ability of a person to perceive the gravitational vertical, and a tilt in SVV indicates vestibular imbalance in the roll plane and, thus, injuries to the utricle or its connecting nerves [ 7 ]. Although measurements of the perceived visual vertical disclose mainly vestibular dysfunctions when no cues to visual spatial orientation are provided during testing [ 8 ], several studies have found that the SVV is altered in neurological patients, mainly with stroke [ 9 ]; in subjects with spinal diseases [ 10 ]; and in patients with peripheral vestibular disorders [ 11 , 12 ].…”