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Enhanced measures to quantify gait and balance impairment in degenerative cervical myelopathy: A prospective cohort
Khadija Soufi1,2, Omar Ortuno1,2, Tiffany Chu1,3
1Spinal Cord Injury, Function and Imaging Laboratory, Department of Neurosurgery, University of California, Davis, California, United States.
Background:
Gait and balance impairment are primary symptoms of degenerative cervical myelopathy (DCM), but practical measures are lacking leading to delays in diagnosis and intervention. This study evaluated numerous gait and balance measures for their clinical and research utility.
Methods:
A prospective cohort study compared DCM and healthy subjects across several tasks: self-paced and fast-paced gait, tandem gait, tandem stance, single-leg stance, and Romberg with eyes open and closed. Tasks were scored manually and electronically using pressure mat data. Abbreviated Berg Balance (aBB) Scale, modified Japanese Orthopaedic Association (mJOA), and EuroQol 5-dimension were administered. Group comparisons used Mann-Whitney-U tests with Benjamini-Hochberg correction. Convergent validity was assessed with Spearman correlations to mJOA lower extremity (LE) scores. Subgroup analysis evaluated DCM patients with subjectively normal balance (DCM-SNB).
Results:
135 DCM patients and 110 age-matched healthy subjects were analyzed. DCM patients demonstrated impaired tandem gait, single-leg stance, aBB, velocity, gait stability ratio, and gait variability (padj < .001). Strongest correlations with mJOA LE were observed for self-paced walking velocity (r = 0.61) and aBB (r = 0.53). DCM-SNB patients demonstrated deficits in tandem gait and several fast-paced electronic gait metrics (padj < .05). The Modified 10-Step Tandem Gait Score showed impairment in DCM (padj < .001) and DCM-SNB (padj < .05), and moderate correlation with mJOA LE (r = 0.38).
Conclusions:
Gait and balance can be readily assessed in DCM patients using tandem gait, walking velocity, aBB, and single-leg stance. The modified 10-step Tandem Gait Score is a practical tool that demonstrates convergent validity and can detect subtle impairment prior to symptomatic recognition.
