General Session: Cervical Degenerative
Presented by: R. Arakal - View Audio/Video Presentation (Members Only)
R. Haddas(1), R. Arakal(2), S. Aghyarian(1), T. Belanger(3)
(1) Texas Back Institute, Research Foundation, Plano, TX, United States
(2) Texas Back Institute, Plano, TX, United States
(3) Texas Back Institute, Rockwall, TX, United States
Cervical spondylotic myelopathy (CSM) is a neurologic condition resulting from spinal cord compression caused by degenerative narrowing of the cervical spinal canal. Altered gait is a frequent symptom of CSM, and has been reported to be improved by surgical intervention. A stiff or spastic gait is also characteristic of CSM in its later stages. Many clinical studies have determined that individuals with CSM have a slower gait speed, prolonged double support duration and reduced cadence compared to healthy controls. Previous studies also identified reduced knee flexion during swing in the early stages of the disease, and in more severe cases, decreased ankle plantar flexion at the terminal stance and reduced knee flexion during loading response. The purpose of this study was to evaluate the biomechanics of the lower extremities and spine during gait in patients with CSM before surgical intervention and to compare these parameters to an asymptomatic group. Eight patients with symptomatic CSM who have been deemed appropriate surgical candidates were compared to 10 healthy. Clinical gait analysis was performed the week before surgery for the CSM patients. Each subject performed a series of over-ground gait trials with self-selected speed, wearing a pair of athletic shoes and walking 10 meters. Spine and lower extremity kinematics were measured using 51 reflective markers placed on bony landmarks of the trunk and extremities using a video motion capture system. The main dependent variable outcomes were: spatiotemporal parameters, lower extremity and spine joint angle values at initial contact and range of motion (ROM) and peak GRF. The gait data was analyzed with one-way ANOVA to determine differences between groups for each dependent variable. A significantly slower walking speed (CSM: 0.82 vs H: 1.03 m/s p< 0.014), shorter step (R CSM: 0.50 vs H: 0.59 m p< 0.012; L CSM: 0.49 vs H: 0.60 m p< 0.001) and stride length (CSM: 0.98 vs H: 1.18 m p< 0.002) was measured in the CSM patients in comparison to the controls. A significant smaller ankle plantar flexion angle (R CSM: 2.45 vs H: -4.98 deg p< 0.003; L CSM: 0.70 vs H: -5.08 deg p< 0.008) and larger hip flexion angle (R CSM: 8.90 vs H: 2.24 deg p< 0.005; L CSM:7.04 vs H:2.91 deg p< 0.050) found at initial contact. Smaller pelvis ROM (CSM:4.71 vs H:2.19 deg p< 0.050), along with bigger hip ROM (CSM:2.67 vs H:33.87 deg p< 0.050) and knee ROM (CSM:31.52 vs H:4.80 deg p< 0.050) at the sagittal plane found in the CSM patients. Ankle ROM (CSM:10.41 vs H:6.03 deg p< 0.016) at the frontal plane found to be larger as well in the CSM patients. Peak GRF found to be bigger (CSM:682 vs H:501 N p< 0.050) for the CSM group in comparison to the healthy group. Patients with CSM have an altered gait pattern in comparison to healthy controls. Based on our preliminary results, CSM patients walk slower with reduced trunk and lower extremity function and efficiency in comparison to an asymptomatic group. Formal gait and motion analysis can provide a true and consistent objective method to assess the impact of spinal degeneration on function and changes after treatment.