"Ten second step test" as a new quantifiable parameter of cervical myelopathy.

STUDY DESIGN: A clinical and cohort study. OBJECTIVE: We developed 10 second step test as a quantifiable measure of severity in cervical compressive myelopathy. The purpose is to establish the standard value of 10 second step test and to verify its clinical effectiveness. SUMMARY OF BACKGROUND DATA: In determining the severity of cervical myelopathy, the effects of surgical intervention, or the factors that influence prognosis, it is essential to have an objective and reproducible means of measuring the patient's disability. There were only a few scales to quantify the severity of cervical compressive myelopathy. METHODS: One hundred sixty-three preoperative patients with cervical compressive myelopathy and 1200 healthy volunteers were included. Three tests were performed: the number of steps in 10 seconds, number of finger grip and release (G and R) in 10 seconds and the Japanese Orthopedic Association score for cervical myelopathy (JOA score). The study population included 99 men and 64 women with a mean age of 63.3 years (range, 33-92). RESULTS: The average number of steps in all patients was 10.7 +/- 5.5 before surgery whereas the average number of steps in the control was 19.6 +/- 3.5. The number of steps was significantly lower in patients than in control and decreased with age in both groups. Number of steps significantly correlated with the number of G and R, walking grade of JOA scores, and total JOA score. One hundred twenty-three patients were retested at 12 months after surgery. In this group, the average data of the step test were 10.4 +/- 5.9 before surgery, and 14.0 +/- 5.4 after surgery, showing significant postoperative improvement (P < 0.0001). CONCLUSION: A 10 second step test is an easily performed, quantitative task, and useful in assessing the severity of CSM. Moreover, it can be used in determining the effects of decompressive surgical treatment.

Postoperative changes in spinal cord signal intensity in patients with cervical compression myelopathy: comparison between preoperative and postoperative magnetic resonance images.

OBJECT: Increased signal intensity of the spinal cord on magnetic resonance (MR) imaging was classified pre- and postoperatively in patients with cervical compressive myelopathy. It was investigated whether postoperative classification and alterations of increased signal intensity could reflect the postoperative severity of symptoms and surgical outcomes. METHODS: One hundred and four patients with cervical compressive myelopathy were prospectively enrolled. All were treated using cervical expansive laminoplasty. Magnetic resonance imaging was performed in all patients preoperatively and after an average of 39.7 months postoperatively (range 12-90 months). Increased signal intensity of the spinal cord was divided into 3 grades based on sagittal T2-weighted MR images as follows: Grade 0, none; Grade 1, light (obscure); and Grade 2, intense (bright). The severity of myelopathy was evaluated according to the Japanese Orthopedic Association (JOA) score for cervical myelopathy and its recovery rate (100% = full recovery). RESULTS: Increased signal intensity was seen in 83% of cases preoperatively and in 70% postoperatively. Preoperatively, there were 18 patients with Grade 0 increased signal intensity, 49 with Grade 1, and 37 with Grade 2; postoperatively, there were 31 with Grade 0, 31 with Grade 1, and 42 with Grade 2. The respective postoperative JOA scores and recovery rates (%) were 13.9/56.7% in patients with postoperative Grade 0, 13.2/50.7% in those with Grade 1, and 12.8/40.1% in those with Grade 2, and these differences were not statistically significant. The postoperative increased signal intensity grade was improved in 16 patients, worsened in 8, and unchanged in 80 (77%). There was no significant correlation between the alterations of increased signal intensity and surgical outcomes. CONCLUSIONS: The postoperative increased signal intensity classification reflected postoperative symptomatology and surgical outcomes to some extent, without statistically significant differences. The alteration of increased signal intensity was seen postoperatively in 24 patients (23%) and was not correlated with surgical outcome.