The Prognostic Evalution Of Surgical Treatment For Patients With Cervical Spondylotic Myelopathy Using Gait Analysis

Background:Cervical spondylotic myelopathy(CSM)is a cervical degenerative disease characterized by cervical spinal stenosis and spinal cord compression.Due to constant pressure of spinal cord and long-term lack of blood supply,it causes irreversible damage in CSM patients.The treatment method of CSM contains non-surgical treatment and surgical treatment.If neurological symptoms appear,it has to surgical treatment.The purpose of surgical treatment is stabilized CMS and prevented further deterioration of nerve function.At present,there is no unified standard to evaluate the recovery of motor function after surgical treatment.It shows the significance of gait analysis in diagnosis and treatment of CMS.However,there is little research of gait analysis on CMS.The evaluation of gait analysis remains to be studied on CMS.Objective:To analyze the change of CMS patients before and after surgical treatment with gait analysis,to evaluate the feasibility of gait analysis on motor function recovery of CMS patients with surgical treatment.Methods:In this study,74 CMS patients and 29 healthy volunteers of Department of spinal surgery,the first affiliated hospital of dalian medical university were recruited during December 2016 to June 2018.The gait analysis of CMS patients with 2 days beforesurgical treatment,1 month after surgical treatment,3 month after surgical treatment and 6 month after surgical treatment using wearable portable gait analysis device developed by Dalian University of Technology.Healthy volunteers also performed a gait analysis of the same procedure.Gait cycle,stance duration,swing duration,stance duration ratio,swing duration ratio,stride width,clearance,velocity,negative angle,positive angle were measured.SPSS 22.0 was used to compare independent sample T test,card square test and single factor variance analysis.The P<0.05 means statistically significant of results.Results:Compared with healthy volunteers,there were no significant differences on gait cycle,stance duration and swing duration in CMS patients.But the stance duration ratio was increased and the swing duration ratio,stride width,clearance,velocity,negative angle,and positive angle were decreased in CMS patients,compared with healthy volunteers.The differences were statistically significant.Nurick grading and modified Japanese Orthopaedic Association(mJOA)lower limb motor function scores were performed in CMS patients with 2 days before surgical treatment,1 month after surgical treatment,3 month after surgical treatment and 6 month after surgical treatment.Nurick grading were gradually increased in CMS patients with 2 days before surgical treatment,1 month after surgical treatment,3 month after surgical treatment and 6 month after surgical treatment.mJOA lower limb motor function scores were gradually reduced in CMS patients with 2 days before surgical treatment,1 month after surgical treatment,3 month after surgical treatment and 6 month after surgical treatment.The differences were statistically significant.Gait analysis of CMS patients after surgical treatment:Gait cycle,stance duration and swing duration:There was no significant difference of gait cycle,stance duration and swing duration in CMS patients with 2 days before surgical treatment,1 month after surgical treatment,3 month after surgical treatment and 6 month after surgical treatment.Stance duration ratio and swing duration ratio:Stance duration ratio were gradually reduced in CMS patients with 2 days before surgical treatment,1 month after surgical treatment,3 month aftersurgical treatment and 6 month after surgical treatment.Swing duration ratio were gradually increased in CMS patients with 2 days before surgical treatment,1 month after surgical treatment,3 month after surgical treatment and 6 month after surgical treatment.Stride width,clearance and velocity:Stride width,clearance and velocity were gradually increased in CMS patients with 2 days before surgical treatment,1month after surgical treatment and 3 month after surgical treatment.However,there was no significant difference of stride width,clearance and velocity in CMS patients with 3 month after surgical treatment and 6 month after surgical treatment.Negative angle and positive angle:The absolute value of the negative angle and the positive angle were gradually increased in CMS patients with 2 days before surgical treatment,1 month after surgical treatment and 3 month after surgical treatment.However,there was no significant difference of negative angle and positive angle in CMS patients with 3 month after surgical treatment and 6 month after surgical treatment.Conclusion:1.The wearable portable gait analysis device has broad application prospects in evaluating the surgical prognosis of cervical spondylotic myelopathy.2.The gait cycle,stance duration and swing duration in gait parameters could not be used to evaluate the recovery of lower extremity motor function in CMS patients.3.The stance duration ratio and swing duration ratio in gait parameters could be used to evaluate the recovery of lower extremity motor function in CMS patients.4.Stride width,clearance,velocity in gait parameters could be used to evaluate the recovery of lower extremity motor function in patients with cervical spondylotic myelopathy in the short term(1 month).Whether they could be used to evaluate the recovery of lower limb motor function in the long-term,it remains to be further studied.5.Negative angle and positive angle in gait parameters could be used to evaluate the recovery of lower extremity motor function in CMS patients of the short term(1 to 3month).Whether they could be used to evaluate the recovery of lower limb motor function in the long-term,it remains to be further studied.