Lightning Podiums: Cervical Degenerative - Room 802A
Presented by: K. Ju
R. Haddas(1), K. Ju(2), 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
Background Context: Difficulties with balance and gait are one of the most common manifestations of cervical spondylotic myelopathy (CSM). Previous gait literature has also identified reduced knee flexion during swing in the early stages of the disease, and, in more severe cases, decreased ankle plantar flexion at terminal stance and reduced knee flexion during loading response. Gait analysis uniquely allows the objective evaluation of CSM patients pre- and postoperatively, and the documentation of neurologic recovery postoperatively.
Objective: To evaluate the kinematics of the spine and lower extremities during the gait cycle in CSM patients before and after surgical intervention.
Patient Sample: Twelve patients with symptomatic CSM.
Outcome Measures: Spine and lower extremity angles at the beginning of the gait cycle (aka "initial contact") and their range of motion (ROM) throughout the stance phase of gait.
Methods: Clinical gait analysis was performed one week before surgery (Pre) and 3 months after surgery (Post). Fifty reflective markers (9.5 mm diameter) were utilized to collect full body three-dimensional kinematics using 10 cameras (VICON) at a sampling rate of 100 Hz. Each patient performed a series of over-ground gait trials at a comfortable, self-selected speed. Repeated measurements ANOVA analysis was used to determine differences in spine and lower extremity kinematics in gait patterns in CSM patients before and after surgical intervention.
Results: Knee flexion angle (Pre: 4.48±8.8 vs Post: 0.15±3.8°; p=0.036) decreased and hip (Pre: 17.50±9.9 vs Post: 23.56±9.3°; p=0.050) and head (Pre: -0.12±7.8 vs Post: 8.16±7.5°; p=0.010) angles increased after surgical intervention. No significant differences were found at the cervical spine, lumbar spine, pelvis, and ankle. Knee ROM was significantly larger postoperatively (Pre: 22.33±13.7 vs Post: 29.64±9.6°; p=0.050). As expected, there was a decrease in cervical spine (Pre: 4.90±3.26 vs Post: 0.91±3.1°; p=0.037) and head (Pre: 4.45±2.2 vs Post: 0.51±1.1°; p=0.001) ROM in CSM patients after surgery. No significant ROM difference was found at the lumbar spine, pelvis, hip, and ankle.
Conclusions: Cervical spondylotic myelopathy can clinically present in various ways such as gait disturbance, hand clumsiness, or upper/lower extremity weakness. Variations in clinical symptoms can sometimes lead to late diagnoses or difficulty with monitoring neurologic deterioration. Our study demonstrates that decompressive surgery helps CSM patients enter the gait cycle with a straighter knee and flexed hip along with increased knee ROM and decreased neck and head ROM due to the cervical fusion. It is beneficial to have objective, quantitative data to describe changes in a subjective clinical finding such as gait. This study not only provides a richer understanding of the gait pathology in cervical myelopathy, but uniquely showed that CSM patients enter the gait cycle with abnormal spinal parameters and consequently has altered lower extremity biomechanics.