Medical Student Columbia University Medical Center
Introduction: Ambulation is an important factor affecting quality of life in spine surgical patients. However, among patients undergoing surgery for cervical spondylotic myelopathy (CSM), the likelihood of gait improvement remains unclear. We investigated the likelihood of gait improvement after surgery as well as factors associated with gait dysfunction pre- and postoperatively.
Methods: This was a retrospective analysis of the prospective Quality Outcomes Database (QOD) CSM module. Gait dysfunction was defined as a modified Japanese Orthopedic Association (mJOA) lower limb motor dysfunction score < 4. Patients with or without dysfunction preoperatively were compared. Among those with dysfunction, we also compared those who did and did not improve postoperatively.
Results: Of the 1,141 patients included in the study, 883 (77.4%) had gait dysfunction and 258 (22.6%) did not. At baseline, more patients with gait dysfunction were older (p < 0.001), had higher BMI (p=0.009), were less likely to have private insurance (p < 0.001), and had a higher number of comorbidities. Preoperatively, patients with gait dysfunction had worse VAS neck (p < 0.001) and arm (p=0.008) pain, as well as worse neck disability (NDI) and quality of life (EQ-VAS and EQ-5D) (all p< 0.001). Surgically, more patients with gait dysfunction underwent anterior surgery (p=0.047). Among those with gait dysfunction at baseline, 512 (44.9%) improved at 24 months after surgery and 629 (55.1%) did not. Patients who improved in ambulation also demonstrated greater improvement in VAS neck and arm pain, as well as NDI, EQ-VAS, and EQ-5D scores (all p< 0.001). Using multivariable analyses, there were no significant individual predictors of improved ambulation.
Conclusion : More than 75% of patients who underwent surgery for CSM demonstrated gait dysfunction. Almost half of these patients had better ambulation after surgery. There were no individual predictors of improved ambulation postoperatively. However, patients who did improve reported superior quality of life and decreased pain and disability.
