Influence of Diabetes Mellitus on Surgical Outcomes in Patients with Cervical Myelopathy: A Prospective, Multicenter Study

STUDY DESIGN: Multicenter, prospective study. PURPOSE: To investigate the effects of diabetes mellitus (DM) on surgical outcomes in patients with cervical myelopathy. OVERVIEW OF LITERATURE: To date, few studies have investigated the influence of postoperative blood glucose or glycated hemoglobin (HbA1c) levels on surgical outcomes. METHODS: The participants were patients who underwent surgery for the treatment of cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. The 61 cases were evaluated preoperatively and 1 year postoperatively using the Japanese Orthopaedic Association (JOA) scores and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). The study variables included fasting blood glucose and HbA1c levels measured preoperatively and at 1 week, 4 weeks, and 1 year postoperatively; the F-wave conduction velocity, latency, rate of occurrence, and M-wave latency in the ulnar and tibial nerves were measured preoperatively and at 1 year postoperatively. The patients were divided into a group without diabetes (N group, 42 patients) and a group with diabetes (DM group, 19 patients). We then assessed the associations between the surgical outcomes and each of the study variables. RESULTS: JOA scores significantly improved in both groups; however, no significant between-group differences were found. There was no significant improvement in the JOACMEQ scores, which assessed cervical function, upper and lower limb function, and bladder function in both groups. We then subdivided the DM group into those with a good control of HbA1c after 1 year (DMG group, 12 patients) and those with HbA1c deterioration after 1 year (DMB group, seven patients), prior to comparing the surgical outcomes. The JOACMEQ scores for upper and lower limb function significantly improved in the DMG group (p<0.01). Compared with the DMB group, there were no significant increases in upper or lower limb function scores in the DMG group. CONCLUSIONS: Poor glycemic control might prevent postoperative functional recovery of the spinal cord.

Significance of Stabilometry for Assessing Postoperative Body Sway in Patients with Cervical Myelopathy

STUDY DESIGN: Prospective study. PURPOSE: To examine the changes in body sway using stabilometry in patients who underwent cervical laminoplasty for cervical myelopathy. OVERVIEW OF LITERATURE: Although the patients of cervical myelopathy complain body sway there are few report to examine body sway objectively. METHODS: Patients who received treatment for cervical myelopathy between October 2010 and February 2013 were included. Twenty-one patients underwent cervical laminoplasty (myelopathy group). Body sway was assessed using stabilometry, wherein patients stood on a stabilometer with their eyes closed for 30 seconds. The Romberg ratio, outer peripheral area (OPA) with eyes closed (cm²), and total locus length per unit area (L/A) with eyes closed (/cm) were examined. Examinations were performed preoperatively (at baseline) and at 8 weeks postoperatively. Examination results of patients in the myelopathy group were compared with those of 17 healthy individuals (control group). Clinical symptoms were evaluated using the Japanese Orthopaedic Association scale score (JOA score) and the timed up and go (TUG) test. RESULTS: In the myelopathy and control groups, the mean baseline Romberg ratio, OPA, and L/A were 2.3±1.2, 8.9±5.5 cm², and 14.2±5.3/cm and 1.4±1.0, 4.3±2.8 cm², and 23.7±10.1/cm, respectively. Eight weeks after laminoplasty, only L/A showed significant improvement from baseline in the myelopathy group (23.2±10.1 to 16.8±7.9; p=0.03). The Romberg ratio and OPA showed improvement in the myelopathy group, but the changes were not statistically significant. JOA scores and TUG test results in this group significantly improved from baseline to 8 weeks after laminoplasty (12.7 to 13.4 and 10.8 to 8.0 seconds, respectively; both p<0.05). CONCLUSIONS: L/A is a useful parameter for measuring body sway to assess the recovery of body sway after laminoplasty.

Practicability of Simple-Flexible-Orthosis / 中国康复理论与实践

@#Objective To test the practicability of hand-made type of simple-flexible-orthosis.Methods The correction force of simple-flexible-orthosis made by different materials, and 10 min walking speed and step frequency after wearing orthosis or without orthosis were tested, and a questionnaire was also used to collect the information that the patients using this orthosis during daily living.Results The orthosis made by different materials had different correction force, and the walking speed and step frequency when wearing orthosis were significantly different from that when not wearing orthosis ( P＜0.01).Conclusion After the simple-flexible-orthosis made by different materials is improved, the correction force, walking speed, step frequency have increased, and this orthosis is suitable for mild drop foot in patients with hemiplegia during their daily living.

Application of Simple Flexible Ankle-Foot Orthosis / 中国康复理论与实践

@#Objective To explore the effect of the simple flexible ankle-foot orthosis on the hemiplegic patient's gait.Methods There are 22 hemiplegic patients (observation group) and 21 healthy individuals (control group) involved in the study. The parameters of gait are collected and analyzed.Results With the simple AFO, the walking time and knee flexion degree of the patients at Brunnstrom stage Ⅳ and stageⅤ are close to that of healthy individuals. When the patients at Brunnstrom stage Ⅲ walk with plastic AFO and then with the simple flexible AFO, there is a obvious difference in knee flexion degree at the initial stage of standing between the two situations.Conclusion The simple flexible AFO can improve the walking ability of hemiplegic patient with light tip foot.