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Objective <p>This study aimed to investigate the impact of different body mass index (BMI) categories on postoperative gait parameters and neurological recovery in patients with Cervical Spondylotic Myelopathy (CSM) undergoing Anterior Cervical Discectomy and Fusion (ACDF), and to clarify the relationship between BMI and postoperative functional outcomes as well as its predictive value.</p> Methods <p>A total of 192 CSM patients who underwent ACDF surgery between January 2020 and December 2022 were consecutively enrolled and divided into three groups according to the WHO Asian BMI standards: Normal Weight group (18.5 ≤ BMI &lt; 25&#xa0;kg/m<sup>2</sup>, n = 68), Overweight group (25 ≤ BMI &lt; 30&#xa0;kg/m<sup>2</sup>, n = 66), and Obesity group (BMI ≥ 30&#xa0;kg/m<sup>2</sup>, n = 58). Gait parameters (spatiotemporal parameters, joint kinematics, and angular accelerations) were collected and the modified Japanese Orthopaedic Association (mJOA) score was assessed preoperatively, at 6&#xa0;months, and 2&#xa0;years postoperatively. Recovery differences among groups were compared. Statistical analyses included repeated measures ANOVA, analysis of covariance (ANCOVA), and Receiver Operating Characteristic (ROC) curve analysis.</p> Results <p>At 6&#xa0;months postoperatively, only the Stance Phase percentage was significantly higher in the Obesity group compared to the Normal Weight group (P &lt; 0.05), with no significant inter-group differences observed in other gait parameters or neurological function scores. At 2&#xa0;years postoperatively, multiple gait parameters showed significant gradient differences: step speed, cadence, step length, ankle dorsiflexion angle, knee and hip joint angular accelerations all decreased progressively with increasing BMI (all P &lt; 0.05). The neurological recovery rate (RR) showed a similar gradient (Normal group: 72.51% &gt; Overweight group: 61.82% &gt; Obesity group: 48.30%, P &lt; 0.001). ANCOVA revealed that the BMI category had an independent effect on both step speed and mJOA score at 2&#xa0;years postoperatively (both P &lt; 0.001). ROC curve analysis identified a preoperative BMI of ≥ 26.53&#xa0;kg/m<sup>2</sup> as the cutoff value for predicting poor neurological recovery (defined as RR &lt; 55%) at 2&#xa0;years postoperatively (AUC = 0.819, sensitivity 73.7%, specificity 76.0%).</p> Conclusion <p>The recovery of gait and neurological function in CSM patients after ACDF exhibits a distinct BMI category gradient effect, which becomes fully apparent in the long-term (2&#xa0;years) postoperative period. Obesity is an independent risk factor affecting postoperative functional recovery. A preoperative BMI ≥ 26.53&#xa0;kg/m<sup>2</sup> can effectively predict poor neurological recovery. It is recommended to conduct early BMI assessment for CSM patients scheduled for ACDF and to implement intensive weight management and individualized rehabilitation interventions for those with BMI ≥ 26.53&#xa0;kg/m<sup>2</sup> to optimize long-term functional prognosis.</p>

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Impact of obesity on postoperative gait parameters and neurological recovery in patients with Cervical Spondylotic Myelopathy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月18日

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  • Xuhong Zhang,
  • Haoran Wu,
  • Zichuan Wu,
  • Hanlin Song,
  • Junzhe Sheng,
  • Baifeng Sun,
  • Chen Xu,
  • Min Qi,
  • Yang Liu

摘要

Objective

This study aimed to investigate the impact of different body mass index (BMI) categories on postoperative gait parameters and neurological recovery in patients with Cervical Spondylotic Myelopathy (CSM) undergoing Anterior Cervical Discectomy and Fusion (ACDF), and to clarify the relationship between BMI and postoperative functional outcomes as well as its predictive value.

Methods

A total of 192 CSM patients who underwent ACDF surgery between January 2020 and December 2022 were consecutively enrolled and divided into three groups according to the WHO Asian BMI standards: Normal Weight group (18.5 ≤ BMI < 25 kg/m2, n = 68), Overweight group (25 ≤ BMI < 30 kg/m2, n = 66), and Obesity group (BMI ≥ 30 kg/m2, n = 58). Gait parameters (spatiotemporal parameters, joint kinematics, and angular accelerations) were collected and the modified Japanese Orthopaedic Association (mJOA) score was assessed preoperatively, at 6 months, and 2 years postoperatively. Recovery differences among groups were compared. Statistical analyses included repeated measures ANOVA, analysis of covariance (ANCOVA), and Receiver Operating Characteristic (ROC) curve analysis.

Results

At 6 months postoperatively, only the Stance Phase percentage was significantly higher in the Obesity group compared to the Normal Weight group (P < 0.05), with no significant inter-group differences observed in other gait parameters or neurological function scores. At 2 years postoperatively, multiple gait parameters showed significant gradient differences: step speed, cadence, step length, ankle dorsiflexion angle, knee and hip joint angular accelerations all decreased progressively with increasing BMI (all P < 0.05). The neurological recovery rate (RR) showed a similar gradient (Normal group: 72.51% > Overweight group: 61.82% > Obesity group: 48.30%, P < 0.001). ANCOVA revealed that the BMI category had an independent effect on both step speed and mJOA score at 2 years postoperatively (both P < 0.001). ROC curve analysis identified a preoperative BMI of ≥ 26.53 kg/m2 as the cutoff value for predicting poor neurological recovery (defined as RR < 55%) at 2 years postoperatively (AUC = 0.819, sensitivity 73.7%, specificity 76.0%).

Conclusion

The recovery of gait and neurological function in CSM patients after ACDF exhibits a distinct BMI category gradient effect, which becomes fully apparent in the long-term (2 years) postoperative period. Obesity is an independent risk factor affecting postoperative functional recovery. A preoperative BMI ≥ 26.53 kg/m2 can effectively predict poor neurological recovery. It is recommended to conduct early BMI assessment for CSM patients scheduled for ACDF and to implement intensive weight management and individualized rehabilitation interventions for those with BMI ≥ 26.53 kg/m2 to optimize long-term functional prognosis.