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The Characteristics of Gait Disturbance and Its Relationship with Posterior Tibial Somatosensory Evoked Potentials in Patients with Cervical Myelopathy

Lee, Jung Hwan MD, PhD*; Lee, Sang Ho MD, PhD; Seo, I Suk MT*

doi: 10.1097/BRS.0b013e3181f412d9
Cervical Spine

Study Design. Prospective case control study.

Objective. This study is to investigate the gait characteristics of cervical myelopathy (CM) and to assess the relationship between presence of abnormality of posterior tibial somatosensory evoked potential (PTSEPs) and gait parameters.

Summary of Background Data. Many of CM patients suffer from gait disturbance so that the assessment of walking ability and its restoration are one of main concerns.

Methods. The patients were recruited who had suffered from gait disturbance and were diagnosed as CM by cervical magnetic resonance image (MRI). All subjects underwent three-dimensional gait analysis and PTSEP. Normal persons were recruited as control groups and underwent gait analysis. The CM patients were divided into two groups such as normal and abnormal SEP groups, and two groups were compared as to presence of signal change in MRI and gait parameters.

Results. CM groups revealed significantly lower gait velocity, decreased step length and stride length, and increased double support time. They showed significantly decreased maximal knee flexion angle in swing phase, the decreased plantarflexion angle at push off, and the increased maximal dorsiflexion angle at swing phase in comparison with control group. Abnormal SEP group demonstrated the lower gait velocity and cadence, smaller plantarflexion angle at push off and the larger maximal dorsiflexion angle at swing phase in comparison with normal SEP group. There was no significant relationship between presence of SEP abnormality and signal change of MRI.

Conclusion. CM patients compensated stabilizing balance by decreasing gait velocity and step length as well as increasing step width and double support time. Considering the presence of abnormality of PTSEP was closely related to typical gait characteristics of CM patient, the gait deviation of CM patients was attributed to impaired proprioception of lower limbs and poor stability.

The patients with cervical myelopathy (CM) had typical gait patterns such as short step length and decreased ankle plantarflexion at push off that were associated with impaired proprioception and poor stability of lower limbs. The abnormality of posterior tibial somatosensory evoked potential was related to gait deviation in CM patients.

*Departments of Physical Medicine and Rehabilitation

Neurosurgery, Wooridul Spine Hospital, Seoul, Korea.

Address correspondence and reprints requests to Sang Ho Lee, MD, PhD, Department of Neurosurgery, Wooridul Spine Hospital, 46–17 Chungdam-Dong Gangnam-Gu, Seoul, Korea; E-mail:

Acknowledgment date: April 8, 2010. Revision date: July 24, 2010. Accepted date: July 26, 2010.

There are no potential conflicts of interests with respect to financial or personal relationships.

Supported by Wooridul Spine Foundation.

© 2011 Lippincott Williams & Wilkins, Inc.