| Background: Cervical spondylotic myelopathy(CSM)is an important cause of spinal cord injury worldwide.Due to the aging of population and the gradual decrease of the age of onset of disease,the patients with cervical spondylotic myelopathy are increasing every year,which has become a social problem that has been widely concerned.There is still a lot of controversy on the treatment strategy,the optimal operation timing and the evaluation of operation outcomes in patients with mild to moderate CSM.Related studies have shown that patients with Nurick Grade 2 disease have the greatest likelihood to turn to normal gait.The upper nerves play an important role in controlling lower limb movement,and the primary manifestation of spinal dysfunction is the damage of lower limb balance.So the gait function can reflect the severities of spinal cord compression.Therefore,the objective and quantitative researches on the gait damage of patients with CSM can provide new ideas for early diagnosis,treatment,severity assessment and postoperative evaluation of cervical spondylotic myelopathy.With the development of science and technology,the emergence of new instruments and equipments make gait analysis as a useful tool in clinic.The gait analysis has played an important role in many disciplines of medicine and kinematics.However,just few researches put an eye on gait analysis of CSM,so the gait analysis is more promising in this field.Compared with other traditional scoring systems of CSM,gait analysis has the advantages of objectivity,sensitivity and quantification,so the evaluation system of CSM based on gait analysis is of great significance to solve the current controversy on the diagnosis and treatment of CSM.Objective: To study the gait parameters of Nurick2 and 3 patients with CSM preand post-operation at the same distance,and to compare the gait parameters with those of normal group in order to objectively analysis and accuratelly describe the gait characteristics of patients with grade 2 or 3 disease,and quantitatively compare the difference between gait disturbances and normal gait pattern as well as the operation outcomes of surgical decompression.Methods: 14 patients who were diagnosed as Nurick grade2 or 3 CSM were hospitalized and operated in the Department of Spine in our hospital,and the general data were compared with the normal control group of 28 cases.The gait data of the normal group and the patients pre-and post-operation were collected by using the portable gait analysis system(Gaitsense gait evaluation system)developed by Dalian University of Technology,.Using m JOA lower extremity function score to evaluate the severities of the disease before and after the operation as well as Nurick score.Using R language 3.2.4 for statistical analysis,independent T-test was used to compare the gait parameters between preoperative and normal patients,and T-Test was compared to the difference of gait parameters between preoperative and postoperative patients and m JOA lower extremity function score,which was significantly different in p<0.05.The gait parameters of normal group,patients before and after operation were compared with the LSD-T test at 5% significant levels.Results:(1)There were statistically differences in velocity,the maximum positive angle compared with those of normal people(p<0.05);the support phase ratio,the swing phase ratio,the stride length,the step length,the maximum negative angle,maximal foot clearance compared with normal population was statistically significant(p<0.01).The swing phase ratio,stride length,stride step,velocity,maximum foot clearance,maximum foot angle and maximum foot negative angle were significantly lower than that in normal population,and the support phase ratio increased.(2)One week after operation,the m JOA lower extremity functional score was increased from3.929 to 5.429,the significant difference was statistically significant(p<0.01),the Nurick scores were all improved to grade 1,and the subjectively improvement was obvious.(3)The postoperative gait parameters are compared with the preoperative.There are statistically differences in the support phase ratio,swing phase ratio,velocity(p<0.05),and the stride length,step length,maximal foot clearance,maximum foot angle and maximum foot negative angle are statistically significant compared with the pre-operation(P<0.01).The swing phase ratio and velocity increased after surgery,stride length,step length,maximum negative angle,maximum positive angle and the maximum clearance are significantly increased after the operation,and the support phase ratio decrease.(4)Compared with the normal population,there were no differences in 9 parameters,such as gait cycle,support phase,swing phase,support phase ratio,swing phase ratio,maximum clearance,velocity,maximum positive angle,maximum negative angle,in the paitents one week after operation.There was no statistical significance in the parameters of gait cycle,support phase,swing phase in normal population,preoperative and postoperative patients.Conclusion: The swing phase ratio,stride length,step length,velcity,maximum foot clearance,maximum foot angle,maximum foot negative angle in paitents of Nurick 2 or3 CSM are significantly lower than those in normal population,but the support phase ratio increased.Through gait analysis,the paitents with grade 2 or 3 disease have the potential to resume normal gait.The functional status of spinal cord after decompression operation is improved obviously,the lower limb sensory movement has a stable improvement,and the operative effect is affirmative.Gait analysis provides an objective and quantitative criterion for the evaluation of CSM,and can be used as a supplementary examination method for the diagnosis and treatment of CSM.The portable gait analysis system has wide clinical application prospect in the diagnosis and treatment of CSM because of its simple operation,convenient wearing,high sensitivity and precision. |
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