title: Spasticity, strength, and gait changes after surgery for cervical spondylotic myelopathy: a case report.
abstract: METHODS
  A case report with repeated measures is presented.
  
  
  OBJECTIVE
  To describe an objective method for evaluating changes in upper- and lower-extremity spasticity and strength, as well as temporal and kinematic gait variables, after surgical intervention for cervical spondylotic myelopathy.
  
  
  BACKGROUND
  Degenerative cervical spinal disease is a common disorder, with some form of spondylosis demonstrated radiographically in more than 80% of those older than 55 years. Normative pre- and postoperative objective data quantifying spasticity, strength, and gait do not exist.
  
  
  METHODS
  A 65-year-old woman underwent C2-C3 anterior cervical discectomy and fusion for progressive myelopathy secondary to a spondylosis and disc herniation. The measure for spasticity and strength at the ankles and elbows and a gait analysis were collected before surgery and at 11 days, 3 and 6 months after surgery. Spasticity and strength were assessed using a dynamometer, and a six-camera video system was used to record the gait.
  
  
  RESULTS
  Preoperative left elbow flexor spasticity was more than 10 times greater than the values for the able bodies. It was reduced to normal levels after surgery. Substantial presurgery weakness was present in the elbow flexors and extensors bilaterally. Elbow extensor strength was at able-body levels after surgery. Gait speed was 57% of the able-body level before surgery and 78% of the able-body level 6 months after surgery.
  
  
  CONCLUSIONS
  This case study demonstrated the role of biomechanics in characterizing impairments associated with cervical spondylosis and its surgical intervention. Measures for spasticity, strength, and gait taken before and after surgery indicated a favorable outcome. This report provides a foundation for the continued use of biomechanical methods to measure changes in function and impairments associated with surgical intervention of cervical spine disorders.
authors.affiliation: Barnes-Jewish Hospital, Human Performance Laboratory, St. Louis 63108, USA. jre6264@BJC.org
authors.forename: J R
authors.initials: JR
authors.lastname: Engsberg
authors.forename: Carl
authors.initials: C
authors.lastname: Lauryssen
authors.forename: S A
authors.initials: SA
authors.lastname: Ross
authors.forename: John H
authors.initials: JH
authors.lastname: Hollman
authors.forename: David
authors.initials: D
authors.lastname: Walker
authors.forename: F J
authors.initials: FJ
authors.lastname: Wippold
mesh_terms: D000368:Aged; D000842:Ankle / Q000503:physiopathology; D001696:Biomechanical Phenomena; D003943:Diagnostic Techniques, Neurological; D017586:Diskectomy; D004550:Elbow / Q000503:physiopathology; D005260:Female; D005684:Gait; D020233:Gait Disorders, Neurologic / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery; D009119:Muscle Contraction; D009128:Muscle Spasticity / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D009333:Neck; D011237:Predictive Value of Tests; D020127:Recovery of Function; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery; D013123:Spinal Fusion; D013128:Spinal Osteophytosis / Q000150:complications / Q000601:surgery