10. Cervical decompression surgery improves dynamic balance in cervical spondylotic myelopathy patients

• Published in: The spine journal Vol. 19; no. 9; p. S5
• Main Authors: Haddas, Ram, Arakal, Rajesh G., Belanger, Theodore A., Boah, Akwasi
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.09.2019
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2019.05.023

Difficulties with balance and gait are common manifestations of cervical spondylotic myelopathy (CSM). These patients present with altered balance and more trunk and lower extremity muscle activity when compared to healthy controls. To quantify the extent of change in balance and posture using dynamic testing in a group of CSM patients before and after cervical decompression surgery. Non-randomized, prospective, concurrent cohort study. Twenty-six CSM patients. Romberg's test: sagittal and coronal sway, total sway, and spine and lower extremity iEMG. Tandem gait test: gait speed, step length, step width, and trunk and head flexion angle. All test subjects were fitted with 51 external reflective markers. Surface EMG electrodes were placed on spine and lower extremity muscles. Spine and lower extremity integrated electromyography (iEMG) measurements were obtained. iEMG activity is a graphic representation of the sum total EMG activity over a defined period of time. Similar to a Romberg's test, patients were required to stand erect with their feet together and eyes open in self-perceived balanced and natural position for a full minute. Then, 10 steps of tandem gait were recorded. Data were analyzed with repeated measurement ANOVA. Surgical decompression reduced COM (Pre: 43.42 vs Post: 30.13 cm, p=0.033) and head (Pre: 59.90 vs Post: 41.36 cm, p=0.020) total sway and decreased muscle activity in their Erector Spinae (Pre: 23.59 vs Post: 14.40 mV, p=0.046), Gluteus Maximus (Pre: 17.48 vs Post: 10.37 mV, p=0.044), and Tibialis Anterior (Pre: 24.64 vs Post: 14.49 mV, p=0.037) muscles in CSM patients during the Romberg's test. Furthermore, surgical decompression increased gait speed (Pre: 0.25 vs Post: 0.41 m/s, p=0.013), reduced step length (Pre: 0.38 vs Post: 0.29 m, p=0.042) along with reduction in trunk (Pre: 32.45 vs Post: 19.15°, p=0.021) and head flexion (Pre: 50.11 vs Post: 32.54°, p=0.019) angle during the tandem gait test. Cervical decompression surgery improved dynamic balance in CSM patients. Three months after surgical intervention, CSM patients reduced their total sway. There was less muscle activity during a simple standing task and a reduction in spine and lower extremity energy expenditure. Surgical decompression improved patients balance capability and improved function in the tandem gait test. While most of the balance research in patients with spinal disorders is done based on static imaging and mostly focused on sagittal spinal alignment, this study is the first effort to evaluate global balance as a dynamic test. Quantifying and analyzing the specific balance alterations of patients with CSM not only provides a richer biomechanical understanding of normal and pathological balance, but also provides specific parameters that can be used in evaluating the severity of balance disturbance and postoperative recovery and rehabilitation. This abstract does not discuss or include any applicable devices or drugs.