Muhammad Fauziyya, Baha Alaa, Haynes Grace, Shakir Hakeem, Omini Michael, Martin Michael, Weber Kenneth A, Paliwal Monica, Van Hal Michael, Dickson Douglas, Dhaher Yasin, Zhao Yan Daniel, Smith Zachary A
Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center.
Neurol Clin Pract. 2023 Apr;13(2):e200126. doi: 10.1212/CPJ.0000000000200126. Epub 2023 Mar 8.
Patients with cervical spondylotic myelopathy (CSM) have motor impairments, including weakness, imbalance, and loss of dexterity. The reliable assessment of these symptoms is critical for treatment decisions. This study aimed to determine, for the first time, the use of the NIH Toolbox motor battery (NIHTBm) in the objective assessment of motor deficits in patients with CSM.
Patients with symptoms and MRI evidence of CSM and age-matched healthy controls (HC), with no evidence of spinal disorder or surgery were included in this case-control study based on our inclusion and exclusion criteria. We performed motor tests, dexterity, gait speed, grip strength, and balance tests, using the NIHTBm in patients with CSM and HCs. Motor impairment rates were determined in patients with CSM based on the NIHTBm scores. We determined the association between NIHTBm scores and patient-reported outcome scores; patient-reported outcome measures (the modified Japanese Orthopedic Association [mJOA] and Nurick grade) to determine the association. One-way analysis of variance was used to analyze group differences and the Spearman rank correlation to determine the relationship between assessment scores.
We enrolled 24 patients with CSM with a mean age (SD) of 57.96 (10.61) years and 24 age-matched HCs with a mean age (SD) of 53.17 (6.04) years in this study. Overall, we observed a significant decrease in the motor function T-scores mean (SD): dexterity 31.54 (14.82) vs 51.54 (9.72), grip strength 32.00 (17.47) vs 56.79 (8.46), balance 27.58 (16.65) vs 40.21 (6.35), and gait speed 0.64 (0.18) vs 0.99 (0.17) m/s, in patients with CSM compared with that in HCs. The lower extremity dysfunction scores on the NIHTBm, balance (ρ = -0.67) and gait speed (ρ = -0.62), were associated with higher Nurick grades. We observed a similar but weaker association with the Nurick grades and NIHTBm tests: dexterity (ρ = -0.49) and grip strength (ρ = -0.31) scores. The total motor mJOA showed a positive but weak association with NIHTBm scores, gait speed (ρ = 0.38), balance (ρ = 0.49), grip strength (ρ = 0.41), and dexterity (ρ = 0.45).
Patients with CSM had significantly lower NIHTBm scores compared with HCs. The results from the NIHTBm are consistent with the clinical presentation of CSM showing patients have motor impairments in both upper and lower extremities. As a neurologic-specific scale, NIHTBm should be used in the evaluation and clinical management of patients with CSM.
脊髓型颈椎病（CSM）患者存在运动功能障碍，包括肌无力、平衡失调和灵活性丧失。对这些症状进行可靠评估对于治疗决策至关重要。本研究旨在首次确定美国国立卫生研究院工具箱运动功能测试组合（NIHTBm）在客观评估CSM患者运动功能缺损中的应用。
根据纳入和排除标准，本病例对照研究纳入了有CSM症状及MRI证据的患者以及年龄匹配的健康对照（HC），HC无脊柱疾病或手术史。我们使用NIHTBm对CSM患者和HC进行运动测试、灵活性测试、步态速度测试、握力测试和平衡测试。根据NIHTBm评分确定CSM患者的运动功能缺损率。我们确定NIHTBm评分与患者报告的结局评分之间的关联；采用患者报告的结局指标（改良日本骨科学会[mJOA]评分和努里克分级）来确定这种关联。采用单因素方差分析来分析组间差异，并采用斯皮尔曼等级相关分析来确定评估分数之间的关系。
本研究纳入了24例CSM患者，平均年龄（标准差）为57.96（10.61）岁，以及24例年龄匹配的HC，平均年龄（标准差）为53.17（6.04）岁。总体而言，我们观察到CSM患者的运动功能T评分平均值（标准差）显著降低：灵活性测试中为31.54（14.82），而HC为51.54（9.72）；握力测试中为32.00（17.47），而HC为56.79（8.46）；平衡测试中为27.58（16.65），而HC为40.21（6.35）；步态速度测试中为0.64（0.18）m/s，而HC为0.99（0.17）m/s。NIHTBm上的下肢功能障碍评分，即平衡（ρ = -0.67）和步态速度（ρ = -0.62），与更高的努里克分级相关。我们观察到努里克分级与NIHTBm测试（灵活性[ρ = -0.49]和握力[ρ = -0.31]评分）之间存在类似但较弱的关联。运动功能mJOA总分与NIHTBm评分、步态速度（ρ = 0.38）、平衡（ρ = 0.49）、握力（ρ = 0.41）和灵活性（ρ = 0.45）呈正相关但较弱。
与HC相比，CSM患者的NIHTBm评分显著更低。NIHTBm的结果与CSM的临床表现一致，表明患者上下肢均存在运动功能障碍。作为一种神经特异性量表，NIHTBm应用于CSM患者的评估和临床管理。
