The Effect of Surgical Decompression on Functional Balance Testing in Patients With Cervical Spondylotic Myelopathy

Abstract

Study Design: A prospective cohort study. Objective: Quantify the extent of change in dynamic balance and stability in a group of patients with cervical spondylotic myelopathy (CSM) after cervical decompression surgery and to compare them with matched healthy controls. Summary of Background Data: CSM is a naturally progressive degenerative condition that commonly results in loss of fine motor control in the hands and upper extremities and in gait imbalance. Whereas this was previously thought of as an irreversible condition, more recent studies are demonstrating postoperative improvements in balance and stability. Materials and Methods: Thirty subjects with symptomatic CSM and 25 matched asymptomatic controls between the ages of 45 and 75 years underwent functional balance testing using a 3D motion capture system to gather kinematic and spatiotemporal parameters. CSM subjects underwent testing 1 week before surgery and again 3 months postoperatively. Results: Patients with CSM exhibited markedly diminished balance as indicated by increased sway on a Romberg test and requiring significantly more time and a wider stance to complete tandem gait tests. The surgical intervention resulted in improved balance at the 3-month postoperative time point; however, kinematic and spatiotemporal parameters did not completely normalize to the levels observed in asymptomatic controls. Conclusions: Human motion video capture can be used to robustly quantify balance parameters in the setting of CSM. Compared with healthy controls, such patients exhibited increased standing sway and poorer performance on a tandem gait task. The surgical intervention resulted in significant improvement in many of the measures of functional balance, but overall profiles had not completely returned to normal when measured 3 months after surgery. These data reinforce the importance of operative intervention in the treatment of symptomatic CSM with the goal of halting disease progress but the expectation that balance may actually improve postoperatively.

Postural Body Sway as Surrogate Outcome for Myelopathy in Adrenoleukodystrophy

“…In hereditary spastic paraplegia, a myelopathy resembling that in ALD, postural body sway was significantly higher than in healthy controls and was correlated with muscle strength in the legs (Marsden and Stevenson, 2013). In cervical spondylotic myelopathy, the most common myelopathy, postural body sway was also increased (Yoshikawa et al, 2008;Haddas et al, 2019b) and improved after decompressive surgery (Haddas et al, 2019a). Although these conditions do not have the same pathophysiology as ALD, they indicate that postural sway could be a useful way to measure myelopathy.…”

The Effects of Surgery on Postural Instability in Patients With Cervical Compressive Myelopathy

“…We demonstrated that patients with CCM perceived greater bodily unsteadiness preoperatively as well as had worse objective assessments of postural instability, as reported previously. [19][20][21][22][23][24] In addition, decompressive surgery significantly improved both the subjective perceptions and objective assessments on instability. Furthermore, the present study potentially highlights several observations of surgical outcomes for postural instability in patients with CCM.…”

“…[20][21][22] Two recent studies addressed the surgical outcomes of postural instability in patients with CCM and drew similar conclusions. Haddas et al 24 examined 30 patients with CSM using a 3D motion capture system and demonstrated that surgical intervention resulted in improved standing balance postoperatively; however, the kinematic and spatiotemporal parameters did not completely reach the levels observed in asymptomatic controls. Similarly, Yano et al 23 examined 54 patients with cervical myelopathy using a stabilometer and demonstrated that postural stability was significantly regained during the postoperative period; but, it did not reach comparative levels seen in the healthy population.…”

Cutaneous and muscular afferents from the foot and sensory fusion processing: Physiology and pathology in neuropathies

“…251 Surgical decompression normally enhances balance and gait, but the improvement may not be immediate. 252 In the chronic inflammatory demyelinating polyradiculoneuropathy, affecting both sensory and motor fibres and both distal and proximal nerve segments, body sway is much larger than in healthy subjects, and varies from a mainly ankle to a mainly hip strategy, 253 probably owing to the large extension of the sensory and motor impairment. The poor trunk control in these conditions resembles that observed in spinal cord injury, 254 where abnormal transmission of the somatosensory information to supra-spinal centres and of the descending commands to lower cord levels are accountable for ataxia.…”