Clinical features and surgical outcomes of cervical spondylotic myelopathy in patients aged 80 years or older: a multi-center retrospective study

Abstract

With the aging of the population in developed countries, spine surgeons have recently been more likely to encounter elderly patients in need of treatment. This study investigated whether decompression surgery for cervical spondylotic myelopathy (CSM) in elderly patients aged 80 years or older would likely be a reasonable treatment. We retrospectively reviewed 605 consecutive patients with cervical myelopathy who underwent decompression surgery between 2004 and 2008. Patients with other conditions that could affect functional status or compression factors other than spondylosis were excluded from this study. Of the remaining 189 patients, 161 with CSM whose condition could be evaluated 6 months after surgery were analyzed. The patients were divided into two age groups: 80 years or older (Group A, 37 patients) and younger than 80 years of age (Group B, 124 patients). We evaluated the differences in symptom duration, clinical data, involved levels, surgical outcome, comorbidities, and postoperative complications between the two groups. The symptom duration was significantly shorter in Group A. The average JOA scores preoperatively and 6 months postoperatively were significantly lower in Group A; however, there was no significant difference in the recovery ratio. There were no significant differences in the percentages of patients with comorbidities or those with postoperative complications. Elderly patients aged 80 years or older regained approximately 40% of their function postoperatively, and the incidence of postoperative complication was similar to that in younger patients. Since this age group shows a rapid deterioration after onset, prompt decompression surgery is required.

The effects of surgery on locomotion in elderly patients with cervical spondylotic myelopathy

“…Some authors have reported that surgical outcomes in elderly patients are worse than those in younger patients [1,12,13]. While irreversible functional deficits arising from a damaged spinal cord may occur in elderly patients, several recent articles have reported that elderly patients can achieve a reasonable degree of recovery after decompression surgery [14,15]. We speculated that this controversy may have resulted from a difference in the severity of CSM symptoms and total pre-operative neurological impairment between younger and elderly individuals, in addition to differences in objective measurements among various studies.…”

The relevance of intramedullary high signal intensity and gadolinium (Gd-DTPA) enhancement to the clinical outcome in cervical compressive myelopathy

“…Many authors have recommended surgical decompression for the treatment of CCM [1,7,10]. Although the ''best practice'' approach to the treatment of CCM remains controversial, for patients with both kyphosis and ventral compression the use of a ventral surgical approach may be the most beneficial [6,23].…”

Surgical and general complications in 2,961 Japanese patients with cervical spondylotic myelopathy: Comparison of different age groups

“…Nagashima et al compared 37 patients with CSM >80 years old and 124 patients <80 years old in a multicenter retrospective study and found that lower Japanese orthopaedic association scores before and after surgeries were observed in the elder group, but age was not significantly associated with recovery rate or surgical and general complications 24) . A study of patients with CSM who underwent decompressive surgery in a single institution compared 36 patients !…”