Cervical Decompression Surgery Normalizes Gait Ground Reaction Forces in Patients With Cervical Spondylotic Myelopathy

• Published in: Spine (Philadelphia, Pa. 1976) Vol. 45; no. 18; p. E1134
• Main Authors: Haddas, Ram, Derman, Peter B
• Format: Journal Article
• Language: English
• Published: United States 15.09.2020
• Subjects: Adult; Aged; Cervical Vertebrae - surgery; Cohort Studies; Decompression, Surgical - methods; Electromyography - methods; Female; Gait - physiology; Gait Analysis - methods; Humans; Male; Middle Aged; Prospective Studies; Spinal Cord Compression - physiopathology; Spinal Cord Compression - surgery; Spinal Cord Diseases - physiopathology; Spinal Cord Diseases - surgery; Spondylosis - physiopathology; Spondylosis - surgery
• ISSN: 1528-1159
• DOI: 10.1097/BRS.0000000000003531

Prospective cohort study. Investigate the effect of surgical decompression and fusion on gait ground reaction forces (GRFs) parameters in patients with cervical spondylotic myelopathy (CSM) and to compare these values to those of healthy controls. Surgical intervention to alleviate spinal cord compression is typically recommended in cases of CSM. While the primary aim of surgery is to halt disease progression, the literature suggests that some symptomatic improvement is often observed postoperatively. Gait analysis via measurement of GRFs is a particularly sensitive means of quantifying changes in ambulatory function, but no comprehensive analysis has been published in the setting of CSM. Forty patients with symptomatic CSM underwent gait analysis with measurement of horizontal and vertical GRFs before and 3 months after surgery. Thirty healthy controls (H) underwent the same battery of tests. Comparisons were made between the pre- and postoperative profiles of patients with CSM as well as to that of the control group. Before surgery, patients with CSM exhibited disturbances in GRF magnitudes: significantly greater maximum weight acceptance (Pre: 113.7 vs. H: 101.1% body weight [BW], P = 0.040) and push off forces (Pre: 112.2 vs. H: 101.4% BW, P = 0.044), and timing: maximum weight acceptance occurred earlier while mid-stance (Pre: 15.8 vs. H: 17.8% gait cycle [GC], P = 0.018), toe-off (Pre: 65.0 vs. H: 62.9% GC, P = 0.001), braking (Pre: 55.6 vs. H: 54.2% GC, P = 0.003), and propulsion occurred (Pre: 11.9 vs. H: 10.6% GC, P = 0.011) later compared with healthy controls. Surgery improved all GRF parameters (P < 0.039), but postoperative gait profiles did not completely normalize to levels observed in the control group. These observations combined with published data on gait muscle activation and gait patterns in CSM patients support the idea that patients with CSM have an altered gait profile consistent with a series of poorly controlled near falls. Surgical intervention was observed to produce improvements in but not complete resolution of these gait disturbances. These data provide a more comprehensive understanding of gait in the setting of CSM. 3.