Postural Stability in Cervical Spinal Myelopathy

The Pre-surgery CSM group recruited for VETS (Static Posturography) measurement will also serve as the sample for the change in VETS measurement as a change in centimeters (cm). This is a longitudinal assessment of balance following surgical intervention for CSM.

Time frame: Pre-surgery compared to 2 weeks, 6 weeks, and 6 months post-surgery VETS factors. The Post-surgery endpoints are normally scheduled clinical follow ups.

Population: Subjects were gradually lost to follow-up, leading to a decline in the number of participants analyzed in later sessions.

The postural stability task involves six conditions during which Veterans are instructed to look straight ahead and maintain an upright stance as stably as possible. Veterans are barefooted with feet comfortably placed \ 25 cm apart. The six conditions are (1) Eyes Open (EO) Firm (2) Eyes Closed (EC) Firm, (3) Dynamic Scene (DYN) Firm, (4) EO Foam, (5) EC Foam, and (6) DYN Foam. a) Comparison of CSM vs. Control and within-subject visual (EO,EC, and DYN) and surface conditions (FIRM and FOAM). b) Comparison of balance and posture at Pre-surgery for CSM group to age and gender matched non-CSM controls. Only pre-surgery data in CSM group was collected due to COVID-19.

Time frame: Pre-Surgery compared to otherwise healthy Veterans

Population: COVID facility entry restrictions at the Syracuse VA Medical Center prevented the recruitment of participants who were not already coming to the VA for medical appointments.

From the VETS, a ration of COP sway to determine the degree roll vection is induced.

Time frame: PreSurgery compared to otherwise healthy Veterans

Population: Could not recruit controls due to COVID restrictions

From the VETS, a ratio of COP sway will be used to determine how roll vection is induced by loss of proprioception.

Time frame: PostSurgery compared to otherwise healthy Veterans compared to otherwise healthy Veterans

Population: Could not recruit controls due to COVID restrictions. Only 4 CSM participants were analyzed compared to the 6 anticipated due to data capture failure in 2 participants during DYN Foam condition and facility entrance policies restricted patient flow for the remainder of the study. Three of them had incomplete trial sessions, but this does not affect overall calculation as this was taken into consideration.

From the VETS, a ratio corresponding to the Rhomberg ratio of COP sway will be used to determine the degree static posture depends on visual input. The Romberg test used in posturography compares postural sway in eyes open (EO) and eyes closed (EC) conditions. The Romberg ratio was calculated in the traditional manner, i.e. EC/EO. The ensuing Romberg ratio (EC/EO) is used to assess visual dependency in postural stability. Higher Romberg ratios reflect greater instability with closed eyes, ( a greater amount of postural sway during eyes closed) whereas a ratio \< 1 indicates higher stability in the EC versus EO condition.

Time frame: PreSurgery

From the VETS, a ratio of COP sway will be used to determine the degree of loss of visual information. Loss of visual information compounds reduced proprioceptive ability in static balance.

Time frame: PreSurgery compared to otherwise healthy Veterans

Population: Could not recruit controls due to COVID restrictions

From the VETS, a ratio of COP sway will be used to determine the degree static posture is affected by reduced proprioception.

Time frame: PreSurgery compared to otherwise healthy Veterans

Population: The investigators could not recruit controls due to COVID restrictions

NDI is related to VETS posturography to determine sensitivity of standing posture to degree of disability. The NDI is a 10-item questionnaire addressing function activities (personal care, lifting, reading, work, driving, sleeping, and recreation), pain intensity, concentration, and headache. For each item, patients make their ratings on a 6-point Likert scale with values 0 = no disability and 5 = complete disability. Summed scores for each category are multiplied by 2 to give a total NDI score ranging from 0-100. Score: /50 Transform to percentage score x 100 = %points. Scoring: Example:16 (total scored)50 (total possible score) x 100 = 32% If one section is missed or not applicable the score is calculated: 16 (total scored)45 (total possible score) x 100 = 35.5% Minimum Detectable Change (90% confidence): 5 points or 10 %points

Time frame: PreSurgery compared to otherwise healthy Veterans

Population: The investigators did not recruit any controls as we could not run participants who did not already have a clinical appointment, due to COVID restrictions

The Nurick scale is a 6-grade ordinal scale assessing gait impairment, with grades ranging from 0 (signs and symptoms of root involvement but no evidence of spinal cord disease) to 5 (chair bound or bedridden). The aggregate value of the Nurick scale will be related to posturography. Classification Scheme: * Grade 0: signs or symptoms of root involvement but without evidence of spinal cord disease * Grade 1: signs of spinal cord disease but no difficulty in walking. * Grade 2: slight difficulty in walking which does not prevent full-time employment * Grade 3: difficulty in walking which prevented full time employment or the ability to do all housework, but which was not so severe as to require someone else's help to walk * Grade 4: able to walk only with someone else's help or with the aid of a frame. * Grade 5 : chairbound or bedridden.

Time frame: PreSurgery compared to otherwise healthy Veterans

Population: The investigators did not recruit any controls as we could not run participants who did not already have a clinical appointment, due to COVID restrictions

The SF-36 questionnaire consists of eight scales yielding two summary measures: physical and mental health. The physical health measure includes four scales of physical functioning (10 items), role-physical (4 items), bodily pain (2 items), and general health (5 items). The mental health measure is composed of vitality (4 items), social functioning (2 items), role-emotional (3 items), and mental health (5 items). The SF-36 offers a choice of recall format at a standard (4 week) or acute (1 week) time frame. Likert scales and yes/no options are used to assess function and well-being on this 36-item questionnaire. To score the SF-36, scales are standardized with a scoring algorithm or by the SF-36v2 scoring software to obtain a score ranging from 0 to 100. Higher scores indicate better health status, and a mean score of 50 has been articulated as a normative value for all scales.

Time frame: PreSurgery compared to otherwise healthy Veterans

Population: Healthy controls could not be recruited because of COVID restrictions