Low handgrip strength is associated with impaired gait and dexterity in patients with degenerative cervical myelopathy

Vollständiger Abstract

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Degenerative cervical myelopathy (DCM) is the most common cause of adult spinal cord dysfunction and leads to progressive neurological deficits in gait and hand dexterity. Handgrip strength is a recognized marker of overall muscle strength and has been linked to various clinical outcomes, including frailty and prognosis. This study aimed to evaluate the relationship between handgrip strength, frailty, and functional status in DCM patients. This cross-sectional study included 94 patients (65 males, 29 females; mean age 66.9 years) undergoing surgery for DCM. Preoperatively, we measured handgrip strength, lower extremity extension power (LEP), pinch strength, gait speed (10-m walk test), hand dexterity (counter test), and neurological function (Japanese Orthopaedic Association [JOA] score). We also assessed frailty using the 5-item modified frailty index (mFI-5) and nutritional status using the Geriatric Nutritional Risk Index (GNRI). Handgrip strength showed strong positive correlations with LEP ( r = 0.675, P < .001), gait speed ( r = 0.617, P < .001), hand dexterity ( r = 0.659, P < .001), and pinch strength ( r = 0.723, P < .001). It was also positively correlated with the total JOA score ( r = 0.468, P = .001) and negatively correlated with age (r = −0.468, P < .001) and the mFI-5 score (r = −0.464, P < .001). Handgrip strength was significantly lower in frail patients (19.5 ± 9.7 kg) than in prefrail (25.2 ± 7.1 kg) and robust patients (30.0 ± 7.5 kg) ( P < .001). After adjustment for age and sex, the associations with LEP (partial r = 0.430, P < .001), hand dexterity (partial r = 0.446, P < .001), and pinch strength (partial r = 0.560, P < .001) remained significant after Bonferroni correction, whereas the association with gait speed did not (partial r = 0.257, P = .030). Handgrip strength was associated with gait performance, dexterity, neurological function, and frailty in unadjusted analyses. After adjustment for age and sex, the strongest adjusted associations were with LEP and hand function. Handgrip strength may complement comprehensive preoperative assessment, although prospective validation is required before it can guide clinical management.