Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland.
Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland.
Spine J. 2024 Mar;24(3):406-416. doi: 10.1016/j.spinee.2023.09.030. Epub 2023 Oct 21.
BACKGROUND: Degenerative cervical myelopathy (DCM) is the most common cause of cervical spinal cord dysfunction in adults and the result of chronic degenerative changes of the cervical spine. The compression of the spinal cord can lead to ischemia, inflammation, and neuronal apoptosis with a consequent impairment of the neurological function. Gait impairment is one of the most frequent signs of DCM. PURPOSE: To investigate the changes in spatio-temporal gait parameters assessed using 3D gait analysis in patients affected by DCM compared with healthy controls and the effect of surgical decompression on these parameters. STUDY DESIGN/SETTING: Systematic review and meta-analysis. PATIENT SAMPLE: The meta-analysis included 267 patients with DCM and 276 healthy controls. OUTCOME MEASURES: Spatio-temporal parameters of gait were assessed. The primary outcome was gait speed; the secondary outcomes were cadence, stride length, step width, stride time, single-limb support time, and double-limb support time. METHODS: Studies reporting spatial and/or temporal gait parameters measured using 3D gait analysis in patients with DCM were included. Data sources were Embase, Medline, and the Core Collection of Web of Science. Meta-analyses were performed to investigate the influence of surgical decompression in patients measured before and after surgery as well as to compare gait parameters of patients with DCM with controls. RESULTS: Thirteen studies reporting on 267 patients with DCM and 276 healthy controls met the inclusion criteria. Seven studies compared patients with DCM with healthy controls, three studies compared gait in patients with DCM before and after surgical decompression, and three studies performed both comparisons. Compared with healthy controls, patients with DCM had slower gait speed (Standardized Mean Difference (SMD), -1.49; 95% confidence interval (CI) [-1.86; -1.13]; p<.001), lower cadence (SMD, -0.78; 95%CI [-1.00; -0.56]; p<.001), shorter stride length (SMD, -1.27; 95%CI [-1.53, -1.01]; p<.001), greater step width (SMD, 0.98; 95%CI [0.42, 1.54]; p=.003), longer stride time (SMD, 0.77; 95%CI [0.37, 1.16]; p=.009), single-limb support phase (SMD, -0.68; 95%CI [-1.06; -0.29]; p=.011), and double-limb support phase (SMD 0.84; 95%CI [0.35, 1.32]; p=.012). After surgical decompression, patients with DCM showed an improvement in gait speed (SMD, 0.57 (95%CI [0.29; 0.85]; p=.003) and no significant differences in other spatio-temporal parameters. CONCLUSIONS: Patients with DCM have clearly different spatio-temporal gait parameters than healthy controls. Gait speed is the only spatio-temporal gait parameter that improves significantly after surgical decompression suggesting that gait speed may be an important clinical outcome parameter in patients with DCM.
背景：退行性颈脊髓病（DCM）是成年人颈椎脊髓功能障碍的最常见原因，是颈椎慢性退行性改变的结果。脊髓受压可导致脊髓缺血、炎症和神经元凋亡，从而导致神经功能受损。步态障碍是 DCM 最常见的体征之一。
目的：研究使用三维步态分析评估 DCM 患者与健康对照组之间步态时空参数的变化，以及手术减压对这些参数的影响。
研究设计/设置：系统评价和荟萃分析。
患者样本：荟萃分析纳入了 267 例 DCM 患者和 276 例健康对照者。
结局测量：评估步态时空参数。主要结局是步态速度；次要结局是步频、步长、步宽、步时、单肢支撑时间和双肢支撑时间。
方法：纳入报告使用三维步态分析测量 DCM 患者空间和/或时间步态参数的研究。数据来源为 Embase、Medline 和 Web of Science 的核心合集。进行荟萃分析以研究手术减压对患者术前和术后的影响，并比较 DCM 患者与对照组的步态参数。
结果：纳入了 13 项研究，共报告了 267 例 DCM 患者和 276 例健康对照者，符合纳入标准。7 项研究比较了 DCM 患者与健康对照组，3 项研究比较了 DCM 患者手术减压前后的步态，3 项研究同时进行了这两项比较。与健康对照组相比，DCM 患者的步态速度较慢（标准化均数差（SMD），-1.49；95%置信区间（CI）[-1.86；-1.13]；p<.001），步频较低（SMD，-0.78；95%CI[-1.00；-0.56]；p<.001），步长较短（SMD，-1.27；95%CI[-1.53，-1.01]；p<.001），步宽较大（SMD，0.98；95%CI[0.42，1.54]；p=.003），步时较长（SMD，0.77；95%CI[0.37，1.16]；p=.009），单肢支撑时间较长（SMD，-0.68；95%CI[-1.06；-0.29]；p=.011），双肢支撑时间较长（SMD，0.84；95%CI[0.35，1.32]；p=.012）。手术后，DCM 患者的步态速度（SMD，0.57（95%CI[0.29；0.85]；p=.003））显著改善，其他时空参数无显著差异。
结论：与健康对照组相比，DCM 患者的时空步态参数明显不同。步态速度是唯一显著改善的时空步态参数，这表明步态速度可能是 DCM 患者的一个重要临床结局参数。
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