Reweighting of the sensory inputs for postural control in patients with cervical spondylotic myelopathy after surgery.
Iu-Shiuan Lin, Dar-Ming Lai, Jian-Jiun Ding and 6 others
PMID 31345240WHAT IT FOUND
Surgery improved walking scores but did not normalize balance.
Patients with cervical myelopathy still relied less on leg sensation and more on vision and inner-ear balance than healthy adults, even six months after decompression. They remain at risk for falls and need specific balance retraining.
Key findings
01Functional walking scores improved significantly after surgery, but patient-reported lower extremity function did not reach statistical significance.
02Six months after surgery, patients still showed lower reliance on proprioceptive inputs and higher reliance on visual and vestibular systems compared to healthy controls.
03Postural sway velocity decreased with eyes open after surgery, but sway remained significantly higher than in healthy controls under both eyes-open and eyes-closed conditions.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study used the Nurick scale to select patients, which measures walking ability rather than balance disturbance, so some participants may have had minor balance issues. Only 4 patients received physical therapy between 3 and 6 months, and the authors claim this did not significantly affect the balance results, but the lack of standardized post-surgical care limits the generalizability of the 'natural history' of recovery. The study did not follow patients beyond 6 months, so it is unknown if sensory reweighting continues to normalize or if deficits persist long-term. Symptom duration and severity varied widely among patients, leading to large standard deviations in the CSM group.
Declared interests
Funded by the Ministry of Science and Technology, Taiwan, and the College of Medicine, National Taiwan University. No commercial conflicts of interest were reported.
The easy way to misread this
Do not interpret the improvement in walking scores (mJOA and Nurick) as evidence that balance has returned to normal. The study shows that while walking ability improves, the underlying sensory weighting for postural control remains abnormal and dependent on vision and vestibular inputs compared to healthy adults.