Radiological and Clinical Outcomes of Anterior Cervical Discectomy and Fusion in Older Patients: A Comparative Analysis of Young-Old Patients (Ages 65–74 Years) and Middle-Old Patients (Over 75 Years)

Lee, Chi Hyung; Son, Dong Wuk; Lee, Su Hun; Lee, Jung Hoon; Sung, Soon Ki; Lee, Sang Weon; Song, Geun Sung

doi:10.14245/ns.1836072.036

Cited by 7 publications

(5 citation statements)

References 33 publications

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“…The clinical outcomes of ADF were limited by various factors, such as duration of symptoms, age, BMI, and preoperative MRI spinal cord signal changes [ 2 , 25 ]. Regarding the association between radiographic parameters and surgical outcomes after ADF, in a retrospective study comparing ADF results between young-old patients and middle-old patients, there was no significant difference in cervical lordosis and C2-7SVA between the two groups and no significant difference in clinical outcomes [ 26 ]. Another retrospective study showed that low postoperative cervical spine alignment change was a risk factor for poor recovery after ADF [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Predictors associated with neurological recovery after anterior decompression with fusion for degenerative cervical myelopathy

et al. 2021

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Background Anterior decompression with fusion (ADF) has often been performed for degenerative cervical myelopathy (DCM) in patients with poor cervical spine alignment and/or anterior cord compression. We aimed to identify clinical and radiological predictors associated with neurological recovery after ADF. Methods This post-hoc analysis from a prospective multicenter study included patients who were scheduled for ADF for DCM. The patients who received other surgeries (laminoplasty, posterior decompression and fusion) were excluded. The associations between baseline clinical and radiographic variables (age, sex, body mass index, etiology, cervical lordosis, range of motion, C7 slope, C2-7 sagittal vertical axis [SVA], thoracic kyphosis [TK], lumbar lordosis, sacral slope, SVA, pelvic tilt, T1 pelvic angle [TPA], the Japanese Orthopedic Association score for the assessment of cervical myelopathy [C-JOA], European Quality of Life Five Dimensions Scale [EQ-5D], Neck Disability Index [NDI], Physical Component Summary of the SF-36 [PCS], and Mental Component Summary of the SF-36) and the recovery rates as the outcome variables were investigated in the univariate regression analysis. Then, the independent predictors for increased recovery rates were evaluated using a stepwise multiple regression analysis. Results In total, 37 patients completed the 1 year follow-up. The recovery rate was significantly correlated with SVA (p = 0.001) and TPA (p = 0.03). Univariate regression analyses showed that age (Regression coefficient = − 0.92, p = 0.049), SVA (Regression coefficient = − 0.57, p = 0.004) and PCS (Regression coefficient = 0.80, p = 0.03) score were significantly associated with recovery rate. Then, a stepwise multiple regression analysis identified the independent predictors of recovery rate after ADF as TK (p = 0.01), PCS (p = 0.03), and SVA (p = 0.03). According to this prediction model, the following equation was obtained: recovery rate = − 8.26 + 1.17 × (TK) − 0.45 × (SVA) + 0.85 × (PCS) (p = 0.002, R2 = 0.44). Conclusion Patients with lower TK, lower PCS score, and higher SVA were more likely to have poor neurological recovery after ADF. Therefore, patients with DCM and these predictors who undergo ADF should be warned about poor recovery and be required to provide adequate informed consent.

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Section: Discussionmentioning

confidence: 99%

Predictors associated with neurological recovery after anterior decompression with fusion for degenerative cervical myelopathy

et al. 2021

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“…The clinical outcomes of ADF were limited by various factors, such as duration of symptoms, age, BMI, and preoperative MRI spinal cord signal changes [2,25]. Regarding the association between radiographic parameters and surgical outcomes after ADF, in a retrospective study comparing ADF results between young-old patients and middle-old patients, there was no signi cant difference in cervical lordosis and C2-7SVA between the two groups and no signi cant difference in clinical outcomes [26]. Another retrospective study showed that low postoperative cervical spine alignment change was a risk factor for poor recovery after ADF [27].…”

Section: Discussionmentioning

confidence: 99%

Predictors associated with neurological recovery after anterior decompression with fusion for degenerative cervical myelopathy

Inose

Hirai²,

Yoshii³

et al. 2021

Preprint

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Background: Anterior decompression with fusion (ADF) has often been performed for degenerative cervical myelopathy (DCM) in patients with poor cervical spine alignment and/or anterior cord compression. We aimed to identify clinical and radiological predictors associated with neurological recovery after ADF.Methods: This post-hoc analysis from a prospective multicenter study included patients who were scheduled for ADF for DCM. The patients who received other surgeries (laminoplasty, posterior decompression and fusion) were excluded. The associations between baseline clinical and radiographic variables (age, sex, body mass index, etiology, cervical lordosis, range of motion, C7 slope, C2-7 sagittal vertical axis [SVA], thoracic kyphosis [TK], lumbar lordosis, sacral slope, SVA, pelvic tilt, T1 pelvic angle [TPA], the Japanese Orthopedic Association score for the assessment of cervical myelopathy [C-JOA], European Quality of Life Five Dimensions Scale [EQ-5D], Neck Disability Index [NDI], Physical Component Summary of the SF-36 [PCS], and Mental Component Summary of the SF-36) and the recovery rates as the outcome variables were investigated in the univariate regression analysis. Then, the independent predictors for increased recovery rates were evaluated using a stepwise multiple regression analysis.Results: In total, 37 patients completed the 1-year follow-up. The recovery rate was significantly correlated with SVA (p = 0.001) and TPA (p = 0.03). Univariate regression analyses showed that age (r = -0.92, p = 0.049), SVA (r = -0.57, p = 0.004) and PCS (r = -0.80, p = 0.03) score were significantly associated with recovery rate. Then, a stepwise multiple regression analysis identified the independent predictors of recovery rate after ADF as TK (p = 0.01), PCS (p = 0.03), and SVA (p = 0.03). According to this prediction model, the following equation was obtained: recovery rate = –8.26 + 1.17 × (TK) – 0.45 × (SVA) + 0.85 × (PCS) (p = 0.002, R2 = 0.44).Conclusion: Patients with lower TK, lower PCS score, and higher SVA were more likely to have poor neurological recovery after ADF. Therefore, patients with DCM and these predictors who undergo ADF should be warned about poor recovery and be required to provide adequate informed consent.

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“…Lee et al (2020) studied differences in elderly patients with cohorts separated into those 65e74 years of age and those age 75 or older, finding no difference between groups after ACDF regarding VAS pain scores, NDI score, or Odom's criteria. 28 Croci et al (2022) separated their patients into three groups: young (<65 years), early elderly (65e74 years), and late elderly (75 years) and found the young patients to have worse significantly worse VAS pain and NDI scores preoperatively and at three and twelve months postoperative compared to the two older cohorts. 29 Further, NDI and VAS arm pain scores improved significantly more in the two older groups at the three-month period; however, overall MCID achievement was greater in VAS arm and NDI for younger patients.…”

Section: Literature Cross-analysismentioning

confidence: 99%

Impact of age within younger populations on outcomes following cervical surgery in the ambulatory setting

Hartman¹,

Nie²,

Pawlowski³

et al. 2022

Journal of Clinical Orthopaedics and Trauma

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Radiological and Clinical Outcomes of Anterior Cervical Discectomy and Fusion in Older Patients: A Comparative Analysis of Young-Old Patients (Ages 65–74 Years) and Middle-Old Patients (Over 75 Years)

Cited by 7 publications

References 33 publications

Predictors associated with neurological recovery after anterior decompression with fusion for degenerative cervical myelopathy

Predictors associated with neurological recovery after anterior decompression with fusion for degenerative cervical myelopathy

Predictors associated with neurological recovery after anterior decompression with fusion for degenerative cervical myelopathy

Impact of age within younger populations on outcomes following cervical surgery in the ambulatory setting

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