Gait impairment in cervical spondylotic myelopathy: comparison with age- and gender-matched healthy controls

Abstract

Introduction: Gait impairment is a primary symptom of cervical spondylotic myelopathy (CSM); however, little is known about specific kinetic and kinematic gait parameters. The objectives of the study were: (1) to compare gait patterns of people with untreated CSM to those of age- and gender-matched healthy controls; (2) to examine the effect of gait speed on kinematic and kinetic parameters.

Materials and methods: Sixteen patients with CSM were recruited consecutively from a neurosurgery clinic, and 16 healthy controls, matched to age (± 5 years) and gender, were recruited for comparison. Patients and controls underwent three-dimensional gait analysis using a Vicon(®) motion analysis system, at self-selected speed over a 10-m track. Controls were also assessed at the speed of their CSM match.

Results: At self-selected speed, the CSM group walked significantly more slowly, with shorter stride lengths and longer double support duration. They showed significant decreases in several kinematic and kinetic parameters, including sagittal range of motion at the hip and knee, ankle plantarflexion, anteroposterior ground reaction force (GRF) at toe-off, power absorption at the knee in loading response and terminal stance, and power generation at the ankle. At matched speed, the CSM group showed significant decreases in knee flexion during swing, total sagittal knee range of motion, peak ankle plantarflexion and anteroposterior GRF.

Conclusion and implications: The findings suggested that people with CSM have significant gait abnormalities that have not been previously reported. In particular, there are key differences in the motor strategies used in the terminal stance phase of gait that cannot be explained by speed alone.

Figures

Fig. 1

Kinematic curves of HC and CSM participants. Significant differences between HC (dashed lines) and CSM (continuous line) are indicated using boxes and arrows; asterisks denotes significant difference at comfortable speed only; double asterisks denotes significant difference at matched speed only. Ant anterior, Post posterior, Flex flexion, Ext extension, Plantar plantarflexion, Dorsi dorsiflexion, Abd abduction, Add adduction, Int internal, Ex = external. Vertical dashed lines indicate toe-off for CSM(black) and HC (grey)

Fig. 2

Kinetic curves of CSM and HC participants. Significant differences between HC (dashed lines) and CSM (continuous line) are indicated using boxes and arrows; asterisks denotes significant difference at comfortable speed only; double asterisks denotes significant difference at matched speed only. Med medial, Lat lateral, N Newtons, kg kilograms, Nm Newton metres, Ant anterior, Post posterior, Ext extensor, Flex flexor, W Watts, kg kilograms, Gen generation, Abs absorption, H Hip power peak, K knee power peak, A ankle power peak. Vertical dashed line indicates toe-off for both groups