Ram Haddas1, Sujal Patel2, Raj Arakal3, Akwasi Boah4, Theodore Belanger5, Kevin L Ju5. 1. Texas Back Institute Research Foundation, 6020 West Parker Rd, Plano, TX 75093, USA. Electronic address: rhaddas@texasback.com. 2. Oasis Medical and Surgical Wellness Group, 85 Harristown Rd, Glen Rock, NJ 07452, USA. 3. Texas Back Institute, 6020 West Parker Rd, Plano, TX 75093, USA. 4. Texas Back Institute, 3537 W Oak St #308, Denton, TX 76201, USA. 5. Texas Back Institute, 3164 Horizon Rd #100, Rockwall, TX 75032, USA.
Abstract
BACKGROUND CONTEXT: Cervical spondylotic myelopathy (CSM) typically manifests with a slow, progressive stepwise decline in neurologic function, including hand clumsiness and balance difficulties. Gait disturbances are frequently seen in patients with CSM, with more advanced cases exhibiting a stiff, spastic gait. PURPOSE: To evaluate the spatiotemporal parameters and spine and lower extremity kinematics during the gait cycle of adult patients with CSM before surgical intervention. STUDY DESIGN: Prospective cohort study. PATIENT SAMPLE: Twenty-eight subjects with symptomatic CSM who have been scheduled for surgery and 30 healthy controls (HC). OUTCOME MEASURES: Spine and lower extremity kinematics and spatiotemporal parameters. METHODS: Clinical gait analysis was performed for patients with CSM and HC. The data were analyzed with a one-way analysis of variance. RESULTS: Patients with CSM have significantly more anterior pelvis tilt (CSM: 13.97°, HC: 5.56°), larger lumbar lordosis (CSM: 8.59°, HC: 2.7°), smaller cervical lordosis (CSM: 6.02°, HC: 11.35°), and less head flexion (CSM: 0.69°, HC: 8.66°) at the beginning of the gait cycle. There was a decrease in knee range of motion in patients with CSM compared with controls (CSM: 36.31°, HC: 50.17°). Furthermore, patients with CSM presented with slower walking speed (CSM: 0.81 m/s, HC: 1.05 m/s), decreased cadence (CSM: 95.57 step/m, HC: 107.64 step/m), increased double support time (CSM: 0.40 s, HC: 0.28 s) and stride time (CSM:1.28 s, HC: 1.13 s), shorter stride length (CSM: 1.04 m, HC: 1.18 m) and step length (CSM:0.51 m, HC: 0.58 m), and wider width (CSM: 0.14 m, HC:0.11 m). CONCLUSIONS: Our study shows that patients with CSM enter the gait cycle with a larger anterior pelvic tilt and lumbar lordosis as well as less cervical lordosis and head flexion. As a consequence of these abnormal spinal parameters at the onset of the gait cycle, lower extremity biomechanics are also altered. Our study is the first to demonstrate the relationship between aberrant spinal alignment and lower extremity function. Identification of this interrelationship as well as the specific gait and biomechanical disturbances seen in myelopathic patients can both inform our understanding of the disease and tailor rehabilitation protocols.
BACKGROUND CONTEXT: Cervical spondylotic myelopathy (CSM) typically manifests with a slow, progressive stepwise decline in neurologic function, including hand clumsiness and balance difficulties. Gait disturbances are frequently seen in patients with CSM, with more advanced cases exhibiting a stiff, spastic gait. PURPOSE: To evaluate the spatiotemporal parameters and spine and lower extremity kinematics during the gait cycle of adult patients with CSM before surgical intervention. STUDY DESIGN: Prospective cohort study. PATIENT SAMPLE: Twenty-eight subjects with symptomatic CSM who have been scheduled for surgery and 30 healthy controls (HC). OUTCOME MEASURES: Spine and lower extremity kinematics and spatiotemporal parameters. METHODS: Clinical gait analysis was performed for patients with CSM and HC. The data were analyzed with a one-way analysis of variance. RESULTS:Patients with CSM have significantly more anterior pelvis tilt (CSM: 13.97°, HC: 5.56°), larger lumbar lordosis (CSM: 8.59°, HC: 2.7°), smaller cervical lordosis (CSM: 6.02°, HC: 11.35°), and less head flexion (CSM: 0.69°, HC: 8.66°) at the beginning of the gait cycle. There was a decrease in knee range of motion in patients with CSM compared with controls (CSM: 36.31°, HC: 50.17°). Furthermore, patients with CSM presented with slower walking speed (CSM: 0.81 m/s, HC: 1.05 m/s), decreased cadence (CSM: 95.57 step/m, HC: 107.64 step/m), increased double support time (CSM: 0.40 s, HC: 0.28 s) and stride time (CSM:1.28 s, HC: 1.13 s), shorter stride length (CSM: 1.04 m, HC: 1.18 m) and step length (CSM:0.51 m, HC: 0.58 m), and wider width (CSM: 0.14 m, HC:0.11 m). CONCLUSIONS: Our study shows that patients with CSM enter the gait cycle with a larger anterior pelvic tilt and lumbar lordosis as well as less cervical lordosis and head flexion. As a consequence of these abnormal spinal parameters at the onset of the gait cycle, lower extremity biomechanics are also altered. Our study is the first to demonstrate the relationship between aberrant spinal alignment and lower extremity function. Identification of this interrelationship as well as the specific gait and biomechanical disturbances seen in myelopathicpatients can both inform our understanding of the disease and tailor rehabilitation protocols.
Authors: Sukhvinder Kalsi-Ryan; Anna C Rienmueller; Lauren Riehm; Colin Chan; Daniel Jin; Allan R Martin; Jetan H Badhiwala; Muhammad A Akbar; Eric M Massicotte; Michael G Fehlings Journal: J Clin Med Date: 2020-03-10 Impact factor: 4.241
Authors: Lindsay Tetreault; Philip Garwood; Aref-Ali Gharooni; Alvaro Yanez Touzet; Laura Nanna-Lohkamp; Allan Martin; Jefferson Wilson; James S Harrop; James Guest; Brian K Kwon; James Milligan; Alberto Martinez Arizala; K Daniel Riew; Michael G Fehlings; Mark R N Kotter; Sukhvinder Kalsi-Ryan; Benjamin M Davies Journal: Global Spine J Date: 2021-12-31