Evaluation of Gait and Functional Stability in Preoperative Cervical Spondylotic Myelopathy Patients.

STUDY DESIGN Prospective Cohort Study. OBJECTIVE The aim of this study was to 1) determine postural stability and spatiotemporal gait parameters and 2) characterize dynamic stability and variances in AM of preoperative CSM patients compared to healthy controls. SUMMARY OF BACKGROUND DATA Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in the world and can lead to significant functional deficits including proprioception and gait disturbances. Biomechanical feedback mechanisms compensating for these deficits, specifically angular momentum (AM) regulation, have remained largely unexplored. METHODS 56 subjects: 32 preoperative Nurick grade 2 or 3 CSM patients and 24 controls were included. Standing balance trials were performed on a single force plate, while walking trials were conducted at self-selected pace over a 15m runway and a series of five force plates. All trials were recorded with 3D motion analysis cameras and gait modeling software was utilized to calculate stability, spatiotemporal gait parameters, and joint kinematics. RESULTS Tilted ellipse area, a measure of center of pressure variance and postural stability, was significantly greater among CSM patients (847.54 ± 764.33mm2 vs. 258.18 ± 103.35mm2, p < 0.001). These patients had two times as much variance medial-lateral (72.12 ± 51.83 mm vs. 29.15 ± 14.95 mm, p = 0.001) and over three times as much anterior-posterior (42.25 ± 55.01 mm vs. 9.17 ± 4.83 mm, p = 0.001) compared to controls. Spatiotemporal parameters indicated that the CSM patients tending to have slower, shorter, and wider gait compared to controls, while spending greater amount of time in double support. Compensatory AM among CSM patients was significantly increased in all three anatomic planes, where whole body AM was approximately double that of controls (0.057 ± 0.034 vs 0.023 ± 0.006), p < 0.001). CONCLUSION Preoperative CSM patients showed significant alterations in spatiotemporal gait parameters and postural stability compared to controls, consistent with prior literature. Likewise, angular momentum analysis demonstrates that these patients have globally increased body excursion to maintain dynamic balance.Level of Evidence: 3.