Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, USA.
Geroscience. 2024 Apr;46(2):2197-2206. doi: 10.1007/s11357-023-00983-3. Epub 2023 Oct 25.
Degenerative cervical myelopathy (DCM) is a leading cause of age-related non-traumatic spinal cord disorders resulting from chronic degeneration of the cervical spine. While traditional clinical assessments rely on patient-reported measures, this study used the NIH Toolbox Motor Battery (NIHTBm) as an objective, quantitative measure to determine DCM severity. The objective is to define NIHTBm cutoff values that can accurately classify the severity of DCM neuromotor dysfunction. A case-controlled pilot study of patients with DCM and age-matched controls. The focus was an in-depth quantitative motor assessment using the NIHTBm to understand the severity of neuromotor deficits due to degenerative spine disease. Motor assessments, dexterity, grip strength, balance, and gait speed were measured in 45 DCM patients and 37 age-matched healthy subjects (HC). Receiver operating curve (ROC) analysis determined cutoff values for mild and moderate-to-severe myelopathy which were validated by comparing motor assessment scores with disability scores. The ROC curves identified thresholds for mild dexterity impairment (T-score range 38.4 - 33.5, AUC 0.77), moderate-to-severe dexterity impairment (< 33.5, AUC 0.70), mild grip strength impairment (47.4 - 32.0, AUC 0.80), moderate-to-severe grip strength impairment (< 32.0, AUC 0.75), mild balance impairment (36.4 - 33.0, AUC 0.61), and moderate-to-severe balance impairment (< 33.0, AUC 0.78). Mild gait speed impairment was defined as 0.78-0.6 m/sec (AUC 0.65), while moderate-to-severe gait speed impairment was < 0.6 m/sec (AUC 0.65). The NIHTB motor score cutoff points correlated negatively with the DCM neck disability index (NDI) and showed balance and dexterity measures as independent indicators of DCM dysfunction. The use of NIHTB allows for precise delineation of DCM severity by establishing cutoff values corresponding to mild and moderate-to-severe myelopathy. The use of NIHTB in DCM allows enhanced clinical precision, enabling clinicians to better pinpoint specific motor deficits in DCM and other neurological disorders with motor deficits, including stroke and traumatic brain injury (TBI). Furthermore, the utility of objective assessment, NIHTB, allows us to gain a better understanding of the heterogeneity of DCM, which will enhance treatment strategies. This study serves as a foundation for future research to facilitate the discovery of innovative treatment strategies for DCM and other neurological conditions.
退行性颈髓病(DCM)是一种与年龄相关的非创伤性脊髓疾病,主要由颈椎慢性退行性变引起。虽然传统的临床评估依赖于患者报告的指标,但本研究使用 NIH 工具包运动电池(NIHTBm)作为一种客观的、定量的测量方法来确定 DCM 的严重程度。目的是确定可以准确分类 DCM 神经运动功能障碍严重程度的 NIHTBm 截断值。对 DCM 患者和年龄匹配的对照组进行病例对照性初步研究。重点是使用 NIHTBm 进行深入的定量运动评估,以了解因退行性脊柱疾病导致的神经运动功能缺损的严重程度。对 45 名 DCM 患者和 37 名年龄匹配的健康受试者(HC)进行了运动评估、灵活性、握力、平衡和步态速度的测量。接收者操作曲线(ROC)分析确定了轻度和中重度脊髓病的截断值,并通过将运动评估评分与残疾评分进行比较来验证这些截断值。ROC 曲线确定了轻度灵活性障碍的阈值(T 评分范围 38.4-33.5,AUC 为 0.77)、中重度灵活性障碍的阈值(<33.5,AUC 为 0.70)、轻度握力障碍的阈值(47.4-32.0,AUC 为 0.80)、中重度握力障碍的阈值(<32.0,AUC 为 0.75)、轻度平衡障碍的阈值(36.4-33.0,AUC 为 0.61)和中重度平衡障碍的阈值(<33.0,AUC 为 0.78)。轻度步态速度障碍定义为 0.78-0.6 m/sec(AUC 为 0.65),中度至重度步态速度障碍定义为<0.6 m/sec(AUC 为 0.65)。NIHTB 运动评分与 DCM 颈部残疾指数(NDI)呈负相关,表明平衡和灵活性测量是 DCM 功能障碍的独立指标。NIHTB 的使用可以通过建立与轻度和中重度脊髓病相对应的截断值来精确划定 DCM 的严重程度。NIHTB 在 DCM 中的应用可以提高临床精度,使临床医生能够更好地确定 DCM 和其他有运动障碍的神经疾病(包括中风和创伤性脑损伤(TBI))中的特定运动缺陷。此外,客观评估 NIHTB 的使用使我们能够更好地了解 DCM 的异质性,从而增强治疗策略。本研究为未来的研究奠定了基础,以促进 DCM 和其他神经疾病的创新治疗策略的发现。
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