Impaired gait is one of the cardinal symptoms of degenerative cervical myelopathy (DCM) and frequently its initial presentation. Quantitative gait analysis is therefore a promising objective tool in the disclosure of early cervical cord impairment in patients with degenerative cervical compression. The aim of this cross-sectional observational cohort study was to verify whether an objective and easily-used walk and run test is capable of detecting early gait impairment in a practical proportion of non-myelopathic degenerative cervical cord compression (NMDCC) patients and of revealing any correlation with severity of disability in DCM. The study group consisted of 45 DCM patients (median age 58 years), 126 NMDCC subjects (59 years), and 100 healthy controls (HC) (55.5 years), all of whom performed a standardized 10-m walk and run test. Walking/running time/velocity, number of steps and cadence of walking/running were recorded; analysis disclosed abnormalities in 66.7% of NMDCC subjects. The DCM group exhibited significantly more pronounced abnormalities in all walk/run parameters when compared with the NMDCC group. These were apparent in 84.4% of the DCM group and correlated closely with disability as quantified by the modified Japanese Orthopaedic Association scale. A standardized 10-m walk/run test has the capacity to disclose locomotion abnormalities in NMDCC subjects who lack other clear myelopathic signs and may provide a means of classifying DCM patients according to their degree of disability.

Central European Institute of Technology Masaryk University 625 00 Brno Czech Republic

Department of Neurology University Hospital 625 00 Brno Czech Republic

Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Zobrazit více v PubMed

Rhee J.M., Heflin J.A., Hamasaki T., Freedman B. Prevalence of Physical Signs in Cervical Myelopathy: A Prospective, Controlled Study. Spine. 2009;34:890–895. doi: 10.1097/BRS.0b013e31819c944b. PubMed DOI

Badhiwala J.H., Ahuja C.S., Akbar M.A., Witiw C.D., Nassiri F., Furlan J.C., Curt A., Wilson J.R., Fehlings M.G. Degenerative Cervical Myelopathy—Update and Future Directions. Nat. Rev. Neurol. 2020;16:108–124. doi: 10.1038/s41582-019-0303-0. PubMed DOI

Keřkovský M., Bednařík J., Jurová B., Dušek L., Kadaňka Z., Kadaňka Z., Němec M., Kovaľová I., Šprláková-Puková A., Mechl M. Spinal Cord MR Diffusion Properties in Patients with Degenerative Cervical Cord Compression. J. Neuroimaging. 2017;27:149–157. doi: 10.1111/jon.12372. PubMed DOI

Nouri A., Tetreault L., Singh A., Karadimas S.K., Fehlings M.G. Degenerative Cervical Myelopathy: Epidemiology, Genetics, and Pathogenesis. Spine. 2015;40:E675–E693. doi: 10.1097/BRS.0000000000000913. PubMed DOI

Kalsi-Ryan S., Karadimas S.K., Fehlings M.G. Cervical Spondylotic Myelopathy: The Clinical Phenomenon and the Current Pathobiology of an Increasingly Prevalent and Devastating Disorder. Neuroscientist. 2013;19:409–421. doi: 10.1177/1073858412467377. PubMed DOI

Tetreault L., Goldstein C.L., Arnold P., Harrop J., Hilibrand A., Nouri A., Fehlings M.G. Degenerative Cervical Myelopathy: A Spectrum of Related Disorders Affecting the Aging Spine. Neurosurgery. 2015;77(Suppl. 4):S51–S67. doi: 10.1227/NEU.0000000000000951. PubMed DOI

Harrop J.S., Naroji S., Maltenfort M., Anderson D.G., Albert T., Ratliff J.K., Ponnappan R.K., Rihn J.A., Smith H.E., Hilibrand A., et al. Cervical Myelopathy: A Clinical and Radiographic Evaluation and Correlation to Cervical Spondylotic Myelopathy. Spine. 2010;35:620–624. doi: 10.1097/BRS.0b013e3181b723af. PubMed DOI

Tracy J.A., Bartleson J.D. Cervical Spondylotic Myelopathy. Neurologist. 2010;16:176–187. doi: 10.1097/NRL.0b013e3181da3a29. PubMed DOI

Davies B.M., Mowforth O.D., Smith E.K., Kotter M.R. Degenerative Cervical Myelopathy. BMJ. 2018;360 doi: 10.1136/bmj.k186. PubMed DOI PMC

Smith S.S., Stewart M.E., Davies B.M., Kotter M.R.N. The Prevalence of Asymptomatic and Symptomatic Spinal Cord Compression on Magnetic Resonance Imaging: A Systematic Review and Meta-Analysis. Glob. Spine J. 2020:2192568220934496. doi: 10.1177/2192568220934496. PubMed DOI PMC

Kovalova I., Kerkovsky M., Kadanka Z., Kadanka Z., Nemec M., Jurova B., Dusek L., Jarkovsky J., Bednarik J. Prevalence and Imaging Characteristics of Nonmyelopathic and Myelopathic Spondylotic Cervical Cord Compression. Spine. 2016;41:1908–1916. doi: 10.1097/BRS.0000000000001842. PubMed DOI

Bednarik J., Kadanka Z., Dusek L., Kerkovsky M., Vohanka S., Novotny O., Urbanek I., Kratochvilova D. Presymptomatic Spondylotic Cervical Myelopathy: An Updated Predictive Model. Eur. Spine J. 2008;17:421–431. doi: 10.1007/s00586-008-0585-1. PubMed DOI PMC

Labounek R., Valošek J., Horák T., Svátková A., Bednařík P., Vojtíšek L., Horáková M., Nestrašil I., Lenglet C., Cohen-Adad J., et al. HARDI-ZOOMit Protocol Improves Specificity to Microstructural Changes in Presymptomatic Myelopathy. Sci. Rep. 2020;10:17529. doi: 10.1038/s41598-020-70297-3. PubMed DOI PMC

Kalsi-Ryan S., Rienmueller A.C., Riehm L., Chan C., Jin D., Martin A.R., Badhiwala J.H., Akbar M.A., Massicotte E.M., Fehlings M.G. Quantitative Assessment of Gait Characteristics in Degenerative Cervical Myelopathy: A Prospective Clinical Study. J. Clin. Med. 2020;9:752. doi: 10.3390/jcm9030752. PubMed DOI PMC

Kuhtz-Buschbeck J.P., Jöhnk K., Mäder S., Stolze H., Mehdorn M. Analysis of Gait in Cervical Myelopathy. Gait Posture. 1999;9:184–189. doi: 10.1016/S0966-6362(99)00015-6. PubMed DOI

Singh A., Choi D., Crockard A. Use of Walking Data in Assessing Operative Results for Cervical Spondylotic Myelopathy: Long-Term Follow-up and Comparison with Controls. Spine. 2009;34:1296–1300. doi: 10.1097/BRS.0b013e3181a09796. PubMed DOI

Zheng C.-F., Liu Y.-C., Hu Y.-C., Xia Q., Miao J., Zhang J.-D., Zhang K. Correlations of Japanese Orthopaedic Association Scoring Systems with Gait Parameters in Patients with Degenerative Spinal Diseases. Orthop. Surg. 2016;8:447–453. doi: 10.1111/os.12280. PubMed DOI PMC

Gorter K. Influence of Laminectomy on the Course of Cervical Myelopathy. Acta Neurochir. 1976;33:265–281. doi: 10.1007/BF01886675. PubMed DOI

Lunsford L.D., Bissonette D.J., Zorub D.S. Anterior Surgery for Cervical Disc Disease. Part 2: Treatment of Cervical Spondylotic Myelopathy in 32 Cases. J. Neurosurg. 1980;53:12–19. doi: 10.3171/jns.1980.53.1.0012. PubMed DOI

Kim C.R., Yoo J.Y., Lee S.H., Lee D.H., Rhim S.C. Gait Analysis for Evaluating the Relationship between Increased Signal Intensity on T2-Weighted Magnetic Resonance Imaging and Gait Function in Cervical Spondylotic Myelopathy. Arch. Phys. Med. Rehabil. 2010;91:1587–1592. doi: 10.1016/j.apmr.2010.07.008. PubMed DOI

Martin A.R., De Leener B., Cohen-Adad J., Cadotte D.W., Nouri A., Wilson J.R., Tetreault L., Crawley A.P., Mikulis D.J., Ginsberg H., et al. Can Microstructural MRI Detect Subclinical Tissue Injury in Subjects with Asymptomatic Cervical Spinal Cord Compression? A Prospective Cohort Study. BMJ Open. 2018;8 doi: 10.1136/bmjopen-2017-019809. PubMed DOI PMC

Kadanka Z., Adamova B., Kerkovsky M., Kadanka Z., Dusek L., Jurova B., Vlckova E., Bednarik J. Predictors of Symptomatic Myelopathy in Degenerative Cervical Spinal Cord Compression. Brain Behav. 2017;7:e00797. doi: 10.1002/brb3.797. PubMed DOI PMC

Benzel E.C., Lancon J., Kesterson L., Hadden T. Cervical Laminectomy and Dentate Ligament Section for Cervical Spondylotic Myelopathy. J. Spinal Disord. 1991;4:286–295. doi: 10.1097/00002517-199109000-00005. PubMed DOI

Srinivasan M., Ruina A. Computer Optimization of a Minimal Biped Model Discovers Walking and Running. Nature. 2006;439:72–75. doi: 10.1038/nature04113. PubMed DOI

Moorthy R.K., Bhattacharji S., Thayumanasamy G., Rajshekhar V. Quantitative Changes in Gait Parameters after Central Corpectomy for Cervical Spondylotic Myelopathy. J. Neurosurg. Spine. 2005;2:418–424. doi: 10.3171/spi.2005.2.4.0418. PubMed DOI

Malone A., Meldrum D., Bolger C. Three-Dimensional Gait Analysis Outcomes at 1 Year Following Decompressive Surgery for Cervical Spondylotic Myelopathy. Eur. Spine J. 2015;24:48–56. doi: 10.1007/s00586-014-3267-1. PubMed DOI

Williams G., Morris M.E., Schache A., McCrory P. Observational Gait Analysis in Traumatic Brain Injury: Accuracy of Clinical Judgment. Gait Posture. 2009;29:454–459. doi: 10.1016/j.gaitpost.2008.11.005. PubMed DOI

Singh A., Crockard H.A. Quantitative Assessment of Cervical Spondylotic Myelopathy by a Simple Walking Test. Lancet. 1999;354:370–373. doi: 10.1016/S0140-6736(98)10199-X. PubMed DOI

Yavuzer G., Oken O., Elhan A., Stam H.J. Repeatability of Lower Limb Three-Dimensional Kinematics in Patients with Stroke. Gait Posture. 2008;27:31–35. doi: 10.1016/j.gaitpost.2006.12.016. PubMed DOI

Nishimura H., Endo K., Suzuki H., Tanaka H., Shishido T., Yamamoto K. Gait Analysis in Cervical Spondylotic Myelopathy. Asian Spine J. 2015;9:321–326. doi: 10.4184/asj.2015.9.3.321. PubMed DOI PMC

Cappellini G., Ivanenko Y.P., Poppele R.E., Lacquaniti F. Motor Patterns in Human Walking and Running. J. Neurophysiol. 2006;95:3426–3437. doi: 10.1152/jn.00081.2006. PubMed DOI

Novacheck T.F. The Biomechanics of Running. Gait Posture. 1998;7:77–95. doi: 10.1016/S0966-6362(97)00038-6. PubMed DOI

Bednařík J., Sládková D., Kadaňka Z., Dušek L., Keřkovský M., Voháňka S., Novotný O., Urbánek I., Němec M. Are Subjects with Spondylotic Cervical Cord Encroachment at Increased Risk of Cervical Spinal Cord Injury after Minor Trauma? J. Neurol. Neurosurg. Psychiatry. 2011;82:779–781. doi: 10.1136/jnnp.2009.198945. PubMed DOI

Wilson J.R., Barry S., Fischer D.J., Skelly A.C., Arnold P.M., Riew K.D., Shaffrey C.I., Traynelis V.C., Fehlings M.G. Frequency, Timing, and Predictors of Neurological Dysfunction in the Nonmyelopathic Patient with Cervical Spinal Cord Compression, Canal Stenosis, and/or Ossification of the Posterior Longitudinal Ligament. Spine. 2013;38(Suppl. 1):S37–S54. doi: 10.1097/BRS.0b013e3182a7f2e7. PubMed DOI

Fehlings M.G., Tetreault L.A., Riew K.D., Middleton J.W., Aarabi B., Arnold P.M., Brodke D.S., Burns A.S., Carette S., Chen R., et al. A Clinical Practice Guideline for the Management of Patients with Degenerative Cervical Myelopathy: Recommendations for Patients With Mild, Moderate, and Severe Disease and Nonmyelopathic Patients With Evidence of Cord Compression. Global Spine J. 2017;7(Suppl. 3):70S–83S. doi: 10.1177/2192568217701914. PubMed DOI PMC

Adamova B., Bednarik J., Andrasinova T., Kovalova I., Kopacik R., Jabornik M., Kerkovsky M., Jakubcova B., Jarkovsky J. Does Lumbar Spinal Stenosis Increase the Risk of Spondylotic Cervical Spinal Cord Compression? Eur. Spine J. 2015;24:2946–2953. doi: 10.1007/s00586-015-4049-0. PubMed DOI

A Controlled Single-Centre Pilot Study to Evaluate the Effect of Prophylactic Surgery in Asymptomatic Degenerative Cervical Cord Compression

Quantitative MR Markers in Non-Myelopathic Spinal Cord Compression: A Narrative Review