Singh, Anoushka; (2002) The use of walking parameters in quantifying disease severty in cervical spondylotic myelopathy. Doctoral thesis (Ph.D.), University College London (United Kingdom).

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Abstract

Currently there is much debate concerning the ideal management of cervical spondylotic myelopathy (CSM). There is uncertainty over which patients benefit from surgical decompression, the best timing for such surgery and the best type of surgical procedure to perform. These difficulties arise not only because of the unpredictable rate of disease progression and the variable results of surgical intervention but especially because of the inability to measure quantitatively, reliably and accurately the outcome of surgical intervention. This thesis first uses a questionnaire to determine clinicians' current practice and attitudes in using quantitative measures of CSM severity and reveals their low level of use and a high level of disagreement over which are most appropriate. The demonstrated shortcomings lead in this thesis to the development of a simple walking test involving a timed walk over 30-m. A preliminary study of CSM patients studied before and after surgery reveals that such a walking test satisfies the criteria of a suitable scale of assessment and compares favourably with the most commonly applied existing rating scales. Actual use of the walking test is then demonstrated by a further study designed to look at the immediate and long term outcome of surgical decompression in CSM patients. Patients are followed up for 3 years after surgery and compared with a matched control group of CSM patients who did not undergo surgery. An immediate and maintained benefit is revealed compared to untreated patients who suffer an ongoing deterioration. These changes correlate with those recorded by a number of existing rating scales. Further analysis of the walking data shows that relatively better results can be achieved in older and more severely affected patients. Finally, walking data are compared with radiographic parameters and it is found that the presence of cervical cord T2-weighted MRI signal change correlates with a better outcome from surgery, but this correlation is not strong enough to make predictions in individual patients. In summary, this thesis introduces and shows the usefulness of the walking test in assessment of CSM patients. The relative ease of use of the walking test may mean that it may find utility in normal clinical practice as well as in research trials.

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