87. Effects of spinal decompression on the gait efficiency and balance of cervical spondylotic myelopathy patients: preliminary results

Abstract

BACKGROUND CONTEXT Cervical spondylotic myelopathy (CSM), a progressive degenerative disease of the spine, remains one of the leading causes of spinal cord dysfunction globally. Clinical symptoms of CSM include weakness, paresthesias, gait impairment, and motor deficits, all dependent on the degree of mechanical compression secondary to structural pathologies. Surgical management is the treatment of choice for CSM. Although surgical treatment has been shown to mitigate the progression of myelopathic symptoms, little is known about patient's gait and functional recovery postoperatively. PURPOSE To characterize stability, gait, and energy expenditure following cervical decompression and/or fusion surgery in CSM patients. STUDY DESIGN/SETTING Prospective cohort study. PATIENT SAMPLE Single institutition surgical candiates (40-80 years) with Nurick grade 2 or 3 CSM. OUTCOME MEASURES Six-month spatio-temporal parameters including stride length, walking velocity, cadence, and time spent in double support, as well as total body work and patient static balance measured by path length and ellipse area. METHODS Prospective gait and stability biometric data (via Vicon Plugin-in Gait Model system) was collected on 15/26 patients (5 females and 10 males, age 62.9±10.2 years) with a diagnosis of CSM at three time points: immediately prior to surgery, three and six months following cervical decompression surgery. Our study group was compared to 13/26 control patients (5 males and 8 females, age 51.4±8.7 years) who were never previously treated with spine surgery, diagnosed with CSM, nor had any gait altering pathology. Patient gait was characterized using spatio-temporal parameters including stride length, walking velocity, and time spent in double support. Total mechanical work as well as static balance parameters were also calculated. A t-test and paired t-test were employed to test for difference in measured parameters between our study and control group. Significance was set at P RESULTS Preoperatively, CSM patients take shorter steps (stride length: 0.97±0.98 v. 1.17±0.10m, P CONCLUSIONS CSM patients have significant deficiency in gait parameters, require increased mechanical work to initiate gait, and have decreased stability at baseline compared to control patients. Following cervical decompression, CSM patients show significant improvement in stability at six months. Other spatio-temporal parameters show improvement that is trending toward significance. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.