Gait Analysis by the Severity of Gait Disturbance in Patients with Compressive Cervical Myelopathy.

IF 1.2 Q3 SURGERY
Spine Surgery and Related Research Pub Date : 2023-07-06 eCollection Date: 2023-11-27 DOI:10.22603/ssrr.2023-0104
Tatsuo Makino, Kei Watanabe, Tatsuki Mizouchi, Takaaki Urakawa, Masayuki Ohashi, Hideki Tashi, Keitaro Minato, Yuki Tanaka, Hiroyuki Kawashima
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Abstract

Introduction: Gait disturbance due to compressive cervical myelopathy has been previously described. However, data on how gait disturbance varies with the degree of lower extremity motor impairment are limited. Therefore, we investigated the characteristics of gait analysis based on severity and determined how gait disturbance progresses in compressive cervical myelopathy.

Methods: We enrolled 44 patients (32 men and 12 women; mean age, 65.0 years) out of 108 consecutive patients with compressive cervical myelopathy who underwent spinal cord decompression surgery in our hospital. The exclusion criteria were inability to gait and complications affecting gait. Twenty-two patients with Japanese Orthopaedic Association scores 1 or 2 for lower extremity motor functions were assigned to the severe group, and 22 patients who scored 3 or 4 were assigned to the moderate group. Gait analysis was performed preoperatively using a long thin-type sensor sheet, and 25 healthy volunteers were assigned to the control group.

Results: Stride length, swing phase, and gait speed decreased whereas step angle, stance phase, and double support duration increased as myelopathy progressed. Step width was significantly larger in the severe group than in the moderate and control groups. The cutoff values based on severe myelopathy with the inability to ascend or descend stairs without support were 60% for the stride length percentage of body height and 100 cm/s for gait speed.

Conclusions: Decreases in stride length, swing phase, and gait speed and increases in step angle, stance phase, and double support duration are compensatory changes as cervical myelopathy progresses. Step width is a compensatory change that is not significantly altered in moderate myelopathy but increases when gait becomes affected, such that the patient cannot ascend or descend stairs without support.

根据压缩性颈椎病患者步态紊乱的严重程度进行步态分析
简介压迫性颈椎病导致的步态障碍以前已有描述。然而,关于步态障碍如何随下肢运动障碍程度而变化的数据却很有限。因此,我们研究了基于严重程度的步态分析特征,并确定了压迫性颈椎病患者步态障碍的进展情况:在我院接受脊髓减压手术的 108 例连续性压迫性颈椎病患者中,我们选取了 44 例患者(男性 32 例,女性 12 例;平均年龄 65.0 岁)作为研究对象。排除标准为无法步态和影响步态的并发症。22名日本矫形协会下肢运动功能评分为1分或2分的患者被分配到重度组,22名评分为3分或4分的患者被分配到中度组。术前使用薄型长传感器片进行步态分析,对照组为 25 名健康志愿者:结果:随着脊髓病的发展,步长、摆动阶段和步速均有所下降,而步幅角、站立阶段和双支撑持续时间则有所增加。重度组的步幅明显大于中度组和对照组。根据重度脊髓病无法在无支撑的情况下上下楼梯的情况,步长占身高百分比的临界值为60%,步速为100厘米/秒:结论:随着颈椎病的发展,步长、摆动阶段和步速会减少,而步幅角、站立阶段和双支撑持续时间会增加,这些都是代偿性变化。步幅是一种代偿性变化,在中度脊髓病时变化不大,但当步态受到影响时,步幅就会增加,以至于患者无法在没有支撑物的情况下上下楼梯。
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来源期刊
CiteScore
1.80
自引率
0.00%
发文量
71
审稿时长
15 weeks
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