227. Continued improvement in functional gait and balance parameters to one year following decompression surgery for cervical spondylotic myelopathy

Abstract

<h3>BACKGROUND CONTEXT</h3> Cervical spondylotic myelopathy (CSM) tends to produce a progressive decline in function characterized by gait disturbance, worsening balance and loss of upper extremity dexterity. Traditionally, the goal of decompressive surgery for CSM was to arrest neurological deterioration and prevent further disability rather than to provide functional recovery. In recent years, studies utilizing functional outcome measurements (FOMs) have demonstrated objective improvements in gait and balance dysfunction out to three months after surgery for CSM, but 1-year follow-up has yet to be reported. <h3>PURPOSE</h3> To determine whether the trends in improvements in gait, balance, pain levels, and psychological profiles observed at three months after cervical decompression for CSM continue out to one year postoperatively. <h3>STUDY DESIGN/SETTING</h3> Prospective, concurrent control cohort study. <h3>PATIENT SAMPLE</h3> The study included 22 symptomatic CSM patients, 20 age-matched healthy control volunteers (C). <h3>OUTCOME MEASURES</h3> Gait and balance parameters, neck disability index (NDI), Visual analog scale (VAS) neck, and psychological measures – Tampa Scale for Kinesiophobia (TSK) and Fear Avoidance Beliefs Questionnaire (FABQ). <h3>METHODS</h3> Patients performed gait and balance evaluations prior to surgery (Pre) and at 3 months (Post3) and 12 months (Post12) postoperatively. Functional data were recorded and analyzed using human motion capture and dynamic surface EMG. Patients also completed outcomes questionaries at the same time points. Repeated measurements and one-way analysis of variance (ANOVA) were used to analyze data. <h3>RESULTS</h3> Continued improvement in multiple gait parameters was observed out to one year postoperatively: faster walking speed (Post3: 0.92 vs Post12: 0.99 m/s, p=0.048; C: 1.02 m/s, p>0.050), shorter step time (Post3: 0.44 vs Post12: 0.42 s, p=0.041; C: 0.42 s, p>0.050), and longer step length (Post3: 0.52 vs Post12: 0.55, p=0.048; C: 0.57, p>0.050). Additional gains in balance occurred between 3 and 12 months: head total sway (Post3: 57.70 vs Post12: 51.35 cm, p=0.045 cm; C: 46.42, p>0.050) as well as cone of economy (CoE) dimensions in the coronal plane for both the head (Post3: 3.14 vs Post12: 2.55 cm, p=0.037 cm; C: 2.19, p>0.050) and center of mass (Post3: 2.11 vs Post12: 1.85 cm, p=0.034 cm; C: 1.64, p>0.050). There were significant improvements in all PROMs after surgery: VAS neck (Pre: 5.4, Post3, 2.1, Post12 1.3, p<0.021) and NDI (Pre: 44.6, Post3: 28.5, Post12 20.1, p=0.032). Progressive improvements were observed in TSK and FABQ scores (p<0.050). <h3>CONCLUSIONS</h3> This study reports objective functional measures and psychological outcomes in addition to standard patient-reported outcome measures for CSM patients out to one year postoperatively, thereby providing a comprehensive global assessment of their recovery. Select measures of gait and balance improved at all time points postoperatively and ultimately resembled those of the healthy controls at one year. These results provide important insight regarding the continued recovery that occurs between 3 and 12 months after surgical decompression for CSM. In turn, this information enriches the discussion surgeons can have with patients before and after surgery. FOMs provide both clinicians and patients with a more detailed and sensitive assessment of overall treatment outcomes and the timeframe of functional recovery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.