Subclinical gait disturbance and postoperative gait improvement in patients with degenerative cervical myelopathy

Abstract

This study aimed to evaluate the subclinical gait abnormalities and the postoperative gait improvements in patients with degenerative cervical myelopathy using three-dimensional gait analysis. We reviewed the gait analysis of 62 patients who underwent surgical treatment for degenerative cervical myelopathy. The asymptomatic gait group included 30 patients and the gait disturbance group included 32 patients who can walk on their own slowly or need assistive device on stairs. The step width (17.2 cm vs. 15.9 cm, P = 0.003), stride length (105.2 cm vs. 109.1 cm, P = 0.015), and double-limb support duration (13.4% vs. 11.7%, P = 0.027) improved only in the asymptomatic gait group. Preoperatively, the asymptomatic gait group exhibited better maximum knee flexion angle (60.5° vs. 54.8°, P = 0.001) and ankle plantarflexion angle at push-off (- 12.2° vs. - 6.5°, P = 0.001) compared to the gait disturbance group. Postoperatively, maximum knee flexion angle (62.3° vs. 58.2°, P = 0.004) and ankle plantarflexion angle at push-off (- 12.8° vs. - 8.3°, P = 0.002) were still better in the asymptomatic gait group, although both parameters improved in the gait disturbance group (P = 0.005, 0.039, respectively). Kinematic parameters could improve in patients with gait disturbance. However, temporospatial parameters improvement may be expected when the operative treatment is performed before apparent gait disturbance.

Figure 1

Kinematic graphs of the pelvis, hip, knee, and ankle before and after surgery. Preoperatively, knee flexion during the swing phase and ankle plantarflexion at push-off were decreased in the gait disturbance group compared to the asymptomatic gait group. These factors improved after surgery, but remained lower than in the asymptomatic gait group. In both groups, the ankle angle at initial contact demonstrated plantarflexion both before and after surgery. Ant anterior, Dor dorsiflexion, Ext extension, Flx flexion, Pla plantarflexion, Pos posterior.