Postoperative Recovery of Gait Function at Early Phase Is Delayed in Patients with Spinal Tumors with Impairment of the Joint Position Sense in the Big Toe: A Retrospective Cohort Study

Abstract

Introduction: We investigated the effect of preoperative joint position sense in the big toe on the postoperative recovery of gait function after spinal tumor surgery.

Methods: Seventy-three patients with spinal tumors who underwent surgery at our hospital between 2014 and 2019 and could be followed for at least 6 months after surgery were included. The patients were divided into the cervical spinal (41 cases) and thoracic spinal (32 cases) groups according to the localization of the tumor. These groups were further classified into an Impaired group (cervical spinal, 34 cases; thoracic spinal, 19 cases) and an Intact group (cervical spinal, 7 cases; thoracic spinal, 13 cases) according to the presence or absence of preoperative joint position sense in the big toe. The amount of change in ambulatory function from the preoperative period to 3 and 6 months postoperatively was compared between the Impaired and Intact groups within each tumor localization category.

Results: Impaired preoperative joint position sense in the big toe in patients undergoing thoracic spinal tumor surgery delayed the recovery of gait function in the early postoperative period.

Conclusions: In patients with thoracic spinal tumor surgery, the absence of preoperative joint position sense in the big toe delayed the recovery of postoperative gait function.

Keywords: gait function; joint position sense; spinal tumors.

Figure 1.

Flow diagram of the process of the study.

Figure 2.

Change in gait function from the preoperative period in the Impaired and Intact groups of the cervical spinal and thoracic spinal groups. The changes in gait function from baseline at 3 months postoperatively in the cervical spinal group were −0.39 (95% CI: −1.15–0.36, P=0.30) in the Impaired group and 0.11 (95% CI: −0.20–0.42, P=0.48) in the Intact group. The changes in gait function from baseline at 6 months postoperatively were −0.32 (95% CI: −1.08–0.44, P=0.39) in the Impaired group and 0.24 (95% CI: −0.07–0.56, P=0.13) in the Intact group. There was no significant difference between the two groups at 3 and 6 months postoperatively. The changes in gait function from baseline at 3 months postoperatively in the thoracic spinal group were −0.03 (95% CI: −0.56–0.48, P=0.87) in the Impaired group and 0.50 (95% CI: 0.07–0.92, P=0.02) in the Intact group. The changes in gait function from baseline at 6 months postoperatively were −0.001 (95% CI: −0.52–0.52, P=0.99) in the Impaired group and 0.76 (95% CI: 0.33–1.19, P=0.001) in the Intact group. There was a significant difference between the two groups at 6 months postoperatively.

Figure 3.

Change in JOA score from the preoperative period in the Impaired and Intact groups of the cervical spinal and thoracic spinal groups. The changes in JOA score from baseline at 3 months postoperatively in the cervical spinal group were 1.03 (95% CI: 0.35–1.71, P=0.0038) in the Impaired group and 1.68 (95% CI: 0.09–3.26, P=0.03) in the Intact group. The changes in JOA score from baseline at 6 months postoperatively were 1.59 (95% CI: 0.91–2.27, P≤0.0001) in the Impaired group and 2.32 (95% CI: 0.73–3.90, P=0.005) in the Intact group. There was no significant difference between the two groups at 3 months and 6 months postoperatively. The changes in JOA score from baseline at 3 months postoperatively in the thoracic spinal group were 1.78 (95% CI: 0.83–2.74, P=0.0006) in the Impaired group and 2.04 (95% CI: 0.85–3.22, P=0.0014) in the Intact group. The changes in JOA score from baseline at 6 months postoperatively were 2.05 (95% CI: 1.09–3.00, P=0.0001) in the Impaired group and 2.42 (95% CI: 1.23–3.61, P=0.0002) in the Intact group. There was no significant difference between the two groups at 3 months and 6 months postoperatively.

Figure 4.

Change in lower extremity muscle strength from the preoperative period in the Impaired and Intact groups of the cervical spinal and thoracic spinal groups. The changes in lower extremity muscle strength from baseline at 3 months postoperatively in the cervical spinal group were −1.19 (95% CI: −5.99–3.59, P=0.61) in the Impaired group and −0.31 (95% CI: −2.37–1.74, P=0.76) in the Intact group. The changes in lower extremity muscle strength from baseline at 6 months postoperatively were 0.30 (95% CI: −0.10–0.72, P=0.14) in the Impaired group and 0.34 (95% CI: 0.16–0.52, P=0.0004) in the Intact group. There was no significant difference between the two groups at 3 months and 6 months postoperatively. The changes in lower extremity muscle strength from baseline at 3 months postoperatively in the thoracic spinal group were 3.53 (95% CI: −0.93–8.00, P=0.11) in the Impaired group and 0.21 (95% CI: −3.44–3.86, P=0.90) in the Intact group. The changes in lower extremity muscle strength from baseline at 6 months postoperatively were 3.99 (95% CI: −0.47–8.46, P=0.07) in the Impaired group and 1.47 (95% CI: −2.17–5.13, P=0.41) in the Intact group. There was no significant difference between the two groups at 3 months and 6 months postoperatively.

Figure 5.

Change in lower extremity sensory from the preoperative period in the Impaired and Intact groups of the cervical spinal and thoracic spinal groups. The changes in lower extremity sensory from baseline at 3 months postoperatively in the cervical spinal group were 0.30 (95% CI: −0.10–0.72, P=0.14) in the Impaired group and 0.28 (95% CI: 0.10–0.46, P=0.0002) in the Intact group. The changes in lower extremity sensory from baseline at 6 months postoperatively were 0.30 (95% CI: 0.16–0.52, P=0.0004) in the Impaired group and 0.34 (95% CI: −0.10–0.72, P=0.14) in the Intact group. There was no significant difference between the two groups at 3 months and 6 months postoperatively. The changes in lower extremity sensory from baseline at 3 months postoperatively in the thoracic spinal group were 0.13 (95% CI: 0.20–0.46, P=0.41) in the Impaired group and 0.51 (95% CI: 0.23–0.78, P=0.0006) in the Intact group. The changes in lower extremity sensory from baseline at 6 months postoperatively were 0.17 (95% CI: 1.09–3.00, P=0.0001) in the Impaired group and 0.53 (95% CI: 0.26–0.81, P=0.0004) in the Intact group. There was no significant difference between the two groups at 3 months and 6 months postoperatively.