Feasibility of Neurorehabilitation Using a Hybrid Assistive Limb for Patients Who Underwent Spine Surgery

Table 2

Review of reports of several postoperative spinal diseases.

Diagnosis	Author, year	Sample size, (sex)	Age (years) (mean)	Follow-up (mean)	Outcome measures	Presenting symptoms	Rehabilitation program	Long-term results after surgical treatment
Arachnoid cyst	Bond et al., 2012 [31]	31 (M 14; F 17)	1–17 (8.1)	13 days to 12.6 years (4.4 years)	Categorized as complete remission, improvement, stable, or worse	Pain: 13 cases; Lower extremity weakness: 12 cases; Gait instability: 10 cases; Spasticity: 6 cases; Sensory loss: 3 cases; Bladder dysfunction: 2 cases	N/A	21 patients had complete remission of symptoms; 6 patients had symptom improvement; 3 patients were stable; 1 patient had worsened symptoms
Dural AVF	Behrens and Thron, 1999 [30]	21 (M 18; F 3)	33–75 (57.0)	5 months to 11 years (50 months)	Muscle strength	Flaccid: 9 patients; Spastic: 12 patients	N/A	Improved: 67%; unchanged: 19%; deteriorated: 14%
					Walking distance	Wheelchair: 7 patients	N/A	Improved: 57%; unchanged: 29%; deteriorated: 14%
					Sensory loss	Sensory disturbance: 18 patients	N/A	Improved: 38%; unchanged: 62%
					Pain	No patient	N/A	Improved: 5%; unchanged: 71%; deteriorated: 24%
					BI (score)	70.5 ± 20.43 (range 20–95)	N/A	85.75 ± 13.81 (range 50–100)
	Van Dijk et al., 2002 [32]	49 (M 39; F 10)	28–78 (63)	12 days to 9.9 years (32.9 months)	Aminoff score of disability	The median gait score was 3; The median bladder score was 3	N/A	The median gait score was 2; The median gait score was 2
Cervical OPLL	Onari et al., 2001 [33]	30 (M 22; F 8)	34–61 (51.3)	10–23 years (14.7 years)	Okamoto’s classification for the degree of walking disability	Grade a: no patient; Grade b: 9 patients; Grade c: 18 patients; Grade d: 3 patients	N/A	Improvement: 2 grades in 16 patients; Improvement: 1 grade in 8 patients; Ambulatory deterioration in 6 patients
	Iwasaki et al., 2002 [34]	64 (M 43; F 21)	42–78 (56)	10–16 years (12.2 years)	JOA scoring system for cervical myelopathy	The mean preoperative total JOA score was 8.9; UE motor score: 2.5 ± 1.0; LE motor score: 2.2 ± 0.9; Sensory score: 2.2 ± 1.7; Bladder score: 2.2 ± 0.8	N/A	The mean last follow-up total JOA score was 13.8; UE motor score: 3.5 ± 0.8; LE motor score: 2.9 ± 1.1; Sensory score: 4.6 ± 1.4; Bladder score: 2.7 ± 0.5
Spinal lipoma	Lee et al., 1995 [35]	6 (M 3; F 3)	8–45 (27)	12–96 months (53.8 months)	Clinical and functional classification scheme	Grade I: no patient; Grade II: 3 patients; Grade III: 3 patients; Grade IV: no patient	N/A	Grade І: 1 patient; Grade II: 2 patients; Grade III: 2 patients; Grade IV: 1 patient
Cervical spondylosis	Wang et al., 2004 [36]	204 (M 145; F 59)	36–92 (63)	16 months	Nurick score for myelopathy	Score 0: 6 patients; Score 1: 56 patients; Score 2: 71 patients; Score 3: 28 patients; Score 4: 24 patients; Score 5: 19 patients	N/A	Score 0: 64 patients; Score 1: 72 patients; Score 2: 31 patients; Score 3: 10 patients; Score 4: 19 patients; Score 5: 8 patients
	Singh et al., 2009 [37]	50 (M 36; F 14)	56.7 ± 13.7	3 years	30-m walking test (sec)	53.6 ± 10.3	N/A	38.6 ± 6.9
	Kadaňka et al., 2011 [38]	64 (M, 46; F, 18)		12 years	10-m walking test (sec)		N/A
		Without surgery:	Without surgery: 47–65 (54.5)	12 years	10-m walking test (sec)	7.0 (5.3; 10.7)	N/A	7.1 (5.1; 12.5)
		With surgery:	With surgery: 41–65 (51.0)	12 years	10-m walking test (sec)	8.0 (5.0; 29.8)	N/A	7.3 (5.1; 25.7)
Spinal ependymoma	Li et al., 2013 [39]	38 (M 19; F 19)	11–60 (35.3)	1 year	Modified McCormick classification	Grade I: 18 patients; Grade II: 11 patients; Grade III: 9 patients; Grade IV: 0 patient	N/A	Grade I: 15 patients; Grade II: 14 patients; Grade III: 7 patients; Grade IV: 2 patients
	Kaner et al., 2010 [40]	21 (M, 13; F, 8)	17–57 (34)	12–168 months (54 months)	Modified McCormick classification	Grade I: 11 patients; Grade II: 5 patients; Grade III: 3 patients; Grade IV: 2 patients	They performed rehabilitation from an early postoperative day, but the content and method were not described at all	Grade I: 20 patients; Grade II: 1 patient; Grade III: 0 patient; Grade IV: 0 patient

M = male; F = female; N/A = not available; AVF = arteriovenous fistula; BI = Barthel Index; OPLL = ossification of the posterior longitudinal ligament; JOA = Japanese Orthopaedic Association; UE = upper extremity; LE = lower extremity; the mean ± the standard deviation. Aminoff score of disability (classification of gait disturbance: grade 1: leg weakness or abnormal gait and no restricted activity; grade 2: grade 1 with restricted activity; grade 3: requiring 1 stick or similar support for walking; grade 4: requiring 2 sticks or crutches for walking; and grade 5: unable to stand and confined to bed or wheelchair. Classification of micturition: grade 1: hesitance, urgency, or frequency; grade 2: occasional urinary incontinence or retention; and grade 3: total urinary incontinence or retention). Okamoto’s classification for the degree of walking disability (a: impossible to walk; b: walk with aids; c: independent walk with spasm; d: walk with difficulty, with or without spasm; e: walk easily but difficult to walk continuously; and f: normal or almost normal walking). JOA scoring system for cervical myelopathy (motor function of fingers, shoulder and elbow, and lower extremity; sensory function of upper extremity, trunk, and lower extremity; and bladder function. Total score for a healthy patient = 17. Normal score of UE motor: 4, LE motor: 4, sensory: 6, and bladder: 3). Clinical and functional classification scheme (grade I: neurologically normal, grade II: sensorimotor deficit affecting the function of the involved limb, grade III: more severe neurological deficit, and grade IV: severe deficit). Nurick score for myelopathy (0: root involvement but no evidence of spinal cord disease; 1: spinal cord disease but no difficulty in walking; 2: slight difficulty in walking, but still employable; 3: difficulty in walking preventing full-time work or housework but independent ambulation; 4: able to walk with assistance or a walker; and 5: chair-bound or bedridden). Median (5th–95th percentile range). Modified McCormick classification (grade I: neurologically normal, normal ambulation and professional activity, and minimal dysesthesia; grade II: mild motor and sensory deficit, independent function, and ambulation maintained; grade III: moderate sensorimotor deficit, restriction of function, and independent with an external aid; grade IV: severe sensorimotor deficit, restricted function, and dependent; and grade V: paraplegia and quadriplegia and even/flickering movement).