Texas Back Institute Research Foundation, 6020 West Parker Rd, Plano, TX 75093, USA.
Oasis Medical and Surgical Wellness Group, 85 Harristown Rd, Glen Rock, NJ 07452, USA.
Spine J. 2018 Sep;18(9):1645-1652. doi: 10.1016/j.spinee.2018.04.006. Epub 2018 May 7.
Cervical spondylotic myelopathy (CSM) typically manifests with a slow, progressive stepwise decline in neurologic function, including hand clumsiness and balance difficulties. Gait disturbances are frequently seen in patients with CSM, with more advanced cases exhibiting a stiff, spastic gait.
To evaluate the spatiotemporal parameters and spine and lower extremity kinematics during the gait cycle of adult patients with CSM before surgical intervention.
Prospective cohort study.
Twenty-eight subjects with symptomatic CSM who have been scheduled for surgery and 30 healthy controls (HC).
Spine and lower extremity kinematics and spatiotemporal parameters.
Clinical gait analysis was performed for patients with CSM and HC. The data were analyzed with a one-way analysis of variance.
Patients with CSM have significantly more anterior pelvis tilt (CSM: 13.97°, HC: 5.56°), larger lumbar lordosis (CSM: 8.59°, HC: 2.7°), smaller cervical lordosis (CSM: 6.02°, HC: 11.35°), and less head flexion (CSM: 0.69°, HC: 8.66°) at the beginning of the gait cycle. There was a decrease in knee range of motion in patients with CSM compared with controls (CSM: 36.31°, HC: 50.17°). Furthermore, patients with CSM presented with slower walking speed (CSM: 0.81 m/s, HC: 1.05 m/s), decreased cadence (CSM: 95.57 step/m, HC: 107.64 step/m), increased double support time (CSM: 0.40 s, HC: 0.28 s) and stride time (CSM:1.28 s, HC: 1.13 s), shorter stride length (CSM: 1.04 m, HC: 1.18 m) and step length (CSM:0.51 m, HC: 0.58 m), and wider width (CSM: 0.14 m, HC:0.11 m).
Our study shows that patients with CSM enter the gait cycle with a larger anterior pelvic tilt and lumbar lordosis as well as less cervical lordosis and head flexion. As a consequence of these abnormal spinal parameters at the onset of the gait cycle, lower extremity biomechanics are also altered. Our study is the first to demonstrate the relationship between aberrant spinal alignment and lower extremity function. Identification of this interrelationship as well as the specific gait and biomechanical disturbances seen in myelopathic patients can both inform our understanding of the disease and tailor rehabilitation protocols.
颈椎脊髓病（CSM）通常表现为神经功能的缓慢、进行性逐步下降，包括手部笨拙和平衡困难。CSM 患者经常出现步态障碍，更严重的病例表现为僵硬、痉挛性步态。
评估接受手术治疗的 CSM 成年患者在手术前的步态周期中的时空参数和脊柱及下肢运动学。
前瞻性队列研究。
28 名有症状的 CSM 患者，已安排手术，30 名健康对照（HC）。
脊柱和下肢运动学以及时空参数。
对 CSM 患者和 HC 进行临床步态分析。数据采用单因素方差分析进行分析。
CSM 患者骨盆前倾明显更大（CSM：13.97°，HC：5.56°），腰椎前凸更大（CSM：8.59°，HC：2.7°），颈椎前凸更小（CSM：6.02°，HC：11.35°），头部前屈更小（CSM：0.69°，HC：8.66°）。与对照组相比，CSM 患者的膝关节活动范围减小（CSM：36.31°，HC：50.17°）。此外，CSM 患者的行走速度较慢（CSM：0.81m/s，HC：1.05m/s），步频降低（CSM：95.57 步/m，HC：107.64 步/m），双支撑时间增加（CSM：0.40s，HC：0.28s）和步幅时间增加（CSM：1.28s，HC：1.13s），步幅长度和步长缩短（CSM：1.04m，HC：1.18m），步宽变宽（CSM：0.14m，HC：0.11m）。
我们的研究表明，CSM 患者在进入步态周期时骨盆前倾和腰椎前凸较大，颈椎前凸和头部前屈较小。由于步态周期开始时这些异常的脊柱参数，下肢生物力学也发生了改变。我们的研究首次证明了异常脊柱排列与下肢功能之间的关系。识别这种相互关系以及颈椎病患者特有的步态和生物力学障碍，可以帮助我们更好地了解疾病，并制定康复方案。
