Effect of Cervical Decompression Surgery on Gait in Adult Cervical Spondylotic Myelopathy Patients

Abstract

Study Design: This is a prospective cohort study. Objective: To evaluate the effect of cervical decompression surgery on the biomechanics of the spine and lower extremities in cervical spondylotic myelopathy (CSM) patients and compare with asymptomatic controls. Summary of Background Data: Difficulties with balance and gait are one of the most common manifestations of CSM. Patients with CSM have a slower gait speed, prolonged double support duration, and reduced cadence compared with healthy controls. Surgical decompression was found to improve clinical outcomes, but conflicting results are noted when examining function. Materials and Methods: In total, 25 subjects with symptomatic CSM underwent clinical gait analysis performed a week before (pre) and 3 months after the surgery (post). Clinical gait analysis was performed on 30 matched asymptomatic controls as well. Spine and lower extremity kinematics, spatiotemporal parameters, and clinical outcome were measured. Results: CSM patients demonstrated slower walking speed (P=0.006), reduced cadence (P=0.001), longer step time (P=0.013) wider step width (P=0.001), greater ankle range of motion (ROM) (P=0.019), less hip ROM (P=0.050), increased pelvis (P=0.001), and lumbar spine (P=0.049) ROM compared with controls. Postoperatively CSM patients demonstrated a faster walking speed (P=0.002), increased cadence (P=0.029), longer step length (P=0.015), narrower step width (P=0.004), greater knee (P=0.043), and hip ROM (P=0.007), less pelvis (P=0.002), lumbar spine (P=0.035), and cervical spine (P=0.044) ROM, and improved clinical outcomes (neck pain disability index questionnaire, oswestry disability index, and visual analog scale; P=0.001) compared with their preoperative values. Postsurgical CSM patients did not present with any differences compared with controls, beside pelvis ROM (P=0.019). Conclusions: Preoperatively, CSM patients clearly showed altered gait parameters compared with controls. However, after cervical decompression surgery, CSM patients exhibited improved gait pattern, spatiotemporal parameters, spine and lower extremity ROM, as well as patient-reported outcomes. Postoperatively, CSM patients did not show major differences in gait when compared with matched asymptomatic controls.

Pathophysiological Changes and the Role of Notch-1 Activation After Decompression in a Compressive Spinal Cord Injury Rat Model

“…Thus far, only four studies have investigated the decompressed state of CSM in animal models (Harkey et al, 1995;Karadimas et al, 2015b;Dhillon et al, 2016;Haddas et al, 2018). Harkey et al (1995) demonstrated that decompression can improve neurological function and can alter the necrosis and cavitation of spinal cord tissue in a dog model.…”

Cervical spondylosis in patients presenting with “severe” myelopathy: Analysis of treatment by multisegmental spinal fixation – A case series

“…Longer duration of disease has also been identified to be a poor prognostic factor for recovery. [222728293031] The duration of symptoms in our patients ranged from 15 days to 20 years (average 16 months). Despite this long duration of symptoms, the clinical outcome was uniformly satisfactory.…”

Muscular Activity Modulation During Post-operative Walking With Hybrid Assistive Limb (HAL) in a Patient With Thoracic Myelopathy Due to Ossification of Posterior Longitudinal Ligament: A Case Report

“…Disturbed gait of cervical myelopathy patients has been reported in the literature, characterized by a slower walking speed, shorter step length, longer step time, reduced range of joint motions (62)(63)(64), and altered timing and duration of muscle activities (65). After surgery for cervical decompression, improvement is observed in walking speed, step time, step length, and joint motions (66)(67)(68) and in knee kinetics (69). While the existing studies dealt with cervical myelopathy patients who could ambulate autonomously before and after surgery, in this study, we dealt with a thoracic myelopathy patient who had difficulty walking before and after surgery.…”