Lightning Podiums: Cervical Degenerative - Room 802A

Presented by: T. Belanger

Author(s):

R. Haddas(1), T. Belanger(2), K. Ju(2), R. Arakal(3)

(1) Texas Back Institute, Research Foundation, Plano, TX, United States
(2) Texas Back Institute, Rockwall, TX, United States
(3) Texas Back Institute, Plano, TX, United States

Abstract

Introduction: Cervical spondylotic myelopathy (CSM) is a neurologic condition that results from spinal cord compression due to degenerative changes within the cervical spine. These changes can include disc herniations, disc osteophyte complexes, ligamentum flavum hypertrophy, spondylolisthesis, or cervical kyphosis. CSM is most common after the age of 50 years, but the age of onset is variable depending on the degree of congenital spinal canal narrowing and other factors. Gait imbalance is a frequent symptom of CSM, and has been reported to be improved by surgical intervention. Clinical studies have determined that individuals with CSM have a slower gait speed, prolonged double support duration, and reduced cadence compared to healthy controls. In fact, difficulty with gait and balance are the most common manifestations of CSM. While there may be some debate as to when patients with radiographic cervical stenosis should undergo decompressive surgery, most surgeons will agree on surgery for patients with moderate or severe myelopathy.

Objective: To evaluate the effect of cervical decompression surgery on gait in patients with CSM.

Method: Twelve patients with symptomatic CSM who have been deemed appropriate surgical candidates underwent clinical gait analysis the week before surgery (Pre) and three months (Post) after surgery. Fifty reflective markers were incorporated to collect full body three-dimensional kinematics using 10 cameras. The patients walked at his/her self-selected speed along a 10 meter level walkway. Spatiotemporal parameters (i.e.: gait speed, cadence, single and double support time, and step length and width) were calculated and analyzed with a repeated measurement ANOVA to determine differences between times.

Results: Surgical intervention improved the gait pattern in CSM patients. A significantly faster walking speed (Pre: 0.82±0.1 vs Post: 0.96±0.1 m/s p=0.038) was measured at the three month post-surgery test compared to pre-surgery. Step length (Pre: 0.49±0.1 vs Post: 0.57±0.1 m p=0.049) increased and step width (Pre: 0.15±0.1 vs Post: 0.12±0.0 s p=0.041) decreased by three months after surgery. Cadence, single support time, and double support time did not significantly change after surgery.

Conclusions: Cervical decompression surgery improved the gait pattern in patients with cervical spondylotic myelopathy. Based on our preliminary results, surgical intervention in these patients improved their spatiotemporal gait parameters. The use of gait analysis may be more sensitive and specific than the current patient reported outcome measures when evaluating patients with CSM. Spine care providers should use gait analysis as part of their clinical evaluation to better understand the effects of the disease and its treatment on their patients' gait, function, and, ultimately, quality of life.