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Beitragstitel Gait function in patients with cervical spinal myelopathy before and after decompression surgery: a systematic review and meta-analysis
Beitragscode P20
Autoren
  1. Filippo Mandelli Universitätsspital Basel (USB) Vortragender
  2. Yuancheng Zhang
  3. Corina Nüesch Universitätsspital Basel (USB)
  4. Hannah Ewald
  5. Aghlmandi Soheila
  6. Stefan Schären Universitätsspital Basel
  7. Annegret Mündermann University Hospital Basel
  8. Cordula Netzer Department of Spinal Surgery; University Hospital of Basel; Department of Biomedical Engineering, Department of Clinical Research; University of Basel
Präsentationsform Poster
Themengebiete
  • A03 - Wirbelsäule
Abstract Introduction: Cervical spondylotic myelopathy (CSM) is the most common cause of cervical spinal cord dysfunction in adults and it is the result of chronic degenerative changes of the cervical spine. The compression of the spinal cord leads to ischemia, inflammation, and neuronal apoptosis with a consequent impairment of the neurological function. Gait impairment is one of the most frequent signs of CSM. The aim of this study was to systematically review the literature to investigate the alterations of spatio-temporal parameters of gait in patients affected by CSM.

Methods: Human-based studies assessing and reporting spatial and/or temporal gait parameters in patients with CSM were included. Data sources were Embase, Medline, and the Core Collection of Web of Science. Spatio-temporal parameters of gait were extracted from the full texts. Meta-analyses were performed to investigate differences in gait parameters between patients with CSM and controls and the influence of surgical decompression on gait parameters.

Results: 12 studies reporting on 253 CSM patients and 252 healthy controls met the inclusion criteria. Six studies compared CSM patients with healthy controls, 3 studies compared the same cohorts of CSM patients before and after surgical decompression, and 3 studies performed both comparisons. The mean follow-up time was 11.2 months (ranging from 3 to 32.4 months). Four studies had a level of evidence (LOE) of 2, 8 studies had a LOE of 3. Compared to healthy individuals, CSM patients had slower gait speed (Standardized Mean Difference (SMD) = -1.18 [-1.63, -0.73]), lower cadence (SMD = -0.77 [-0.96, -0.57]), shorter stride length (SMD = -1.27 [-1.57, -1.00]), greater step width (SMD = 0.53 [0.33, 0.74]), and longer stride time (SMD = 0.77 [0.44, 1.09]). No significant differences were found for single and double-limb support time. After surgical decompression, CSM patients showed an improvement in gait speed (postoperative vs. baseline SMD 0.54 [0.27, 0.80]), and no significant differences in other spatio-temporal parameters.

Conclusion: Patients affected by CSM show worse spatio-temporal parameters of gait than healthy people. Gait speed is the only spatio-temporal parameter of gait that improves significantly after surgical decompression, suggesting that changes in gait parameters other than walking speed are not improved by surgical decompression and long-term gait retraining may be warranted.