Effect of Surgery on Gait and Sensory Motor Performance in Patients With Cervical Spondylotic Myelopathy

Abstract

BACKGROUND Cervical spondylotic myelopathy (CSM) is a common disease of aging that leads to gait instability resulting from loss of leg sensory and motor functions. The results of surgical intervention have been studied using a variety of methods, but no test has been reported that objectively measures integrative leg motor sensory functions in CSM patient. OBJECTIVE To determine the feasibility of using a novel Single Leg Squat (SLS) test to measure integrative motor sensory functions in patients with CSM before and after surgery. METHODS Fifteen patients with CSM were enrolled in this prospective study. Clinical data and scores from standard outcomes questionnaires were obtained before and after surgery. Patients also participated in experimental test protocols consisting of standard kinematic gait testing, the Purdue pegboard test, and the novel SLS test. RESULTS The SLS test protocol was well tolerated by CSM patients and generated objective performance data over short test periods. In patients who participated in postoperative testing, the group measures of mean SLS errors decreased following surgery. Gait velocity measures followed a similar pattern of group improvement postoperatively. Practical barriers to implementing this extensive battery of tests resulted in subject attrition over time. Compared to kinematic gait testing, the SLS protocol required less space and could be effectively implemented more efficiently. CONCLUSION The SLS test provides a practical means of obtaining objective measures of leg motor sensory functions in patients with CSM. Additional testing with a larger cohort of patients is required in order to utilize SLS data to rigorously examine group treatment effects.

Reweighting of the sensory inputs for postural control in patients with cervical spondylotic myelopathy after surgery

“…Moreover, various symptoms and signs may affect the prognosis of the surgery. Previous studies have provided inconsistent results regarding the effectiveness of surgery on the gait performance of patients with CSM [8, 9]. Furthermore, no study has discussed postural control in patients with CSM after surgery.…”

Speed, resistance, and unexpected accelerations modulate feed forward and feedback control during a novel weight bearing task

“…Improvements in performance can be achieved even under conditions where a person is denied visual feedback [11, 12], is fatigued [13], older [14], or post-surgical [15, 16]. A limitation of our previous reports is that only a single level of resistance and speed was assessed during the weight bearing task, suggesting that the assessment would show ceiling or floor effects in other populations.…”

Myotonic dystrophy type 1 alters muscle twitch properties, spinal reflexes, and perturbation‐induced trans‐cortical reflexes

“…In the present study, we examined adaptations in trans‐cortical reflexes in a way that replicated a realistic motor challenge; an unexpected perturbation that caused knee buckling. We have previously used this test paradigm to characterize motor responses in healthy subjects, patients with neurologic disease, elders at risk of falls, and as part of a dual‐task cognitive challenge …”

“…Phase III of the experiment (Supporting Information Figure S1C) consisted of movement performance testing designed to examine trans‐cortical sensorimotor reflex pathways (trans‐cortical LLRs). The study used a well‐validated functional weight‐bearing task that elicits LLRs after unexpected perturbations in single limb stance . Subjects stood with the right knee positioned against a padded plate that moved horizontally on a rack and pinion system .…”