The effect of ageing on presentation, management and outcomes in degenerative cervical myelopathy: a systematic review

Abstract

Objective Degenerative cervical myelopathy (DCM) is a disabling neurological condition. The underlying degenerative changes are known to be more common with age, but the impact of age on clinical aspects of DCM has never been synthesised. The objective of this study is to determine whether age is a significant predictor in three domains—clinical presentation, surgical management and post-operative outcomes of DCM. Methods a systematic review of the Medline and Embase databases (inception to 12 December 2019), registered with PROSPERO (CRD42019162077) and reported in accordance with preferred reporting items of systematic reviews and meta-analysis (PRISMA) guidelines, was conducted. The inclusion criteria were full text articles in English, evaluating the impact of age on clinical aspects of DCM. Results the initial search yielded 2,420 citations, of which 206 articles were eventually included. Age was found to be a significant predictor in a variety of measures. Within the presentation domain, older patients have a worse pre-operative functional status. Within the management domain, older patients are more likely to undergo posterior surgery, with more levels decompressed. Within the outcomes domain, older patients have a worse post-operative functional status, but a similar amount of improvement in functional status. Because of heterogenous data reporting, meta-analysis was not possible. Conclusion the current evidence demonstrates that age significantly influences the presentation, management and outcomes of DCM. Although older patients have worse health at all individual timepoints, they experience the same absolute benefit from surgery as younger patients. This finding is of particular relevance when considering the eligibility of older patients for surgery.

A New Framework for Investigating the Biological Basis of Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 5]: Mechanical Stress, Vulnerability and Time

“… 135 , 136 In clinical practice, older age is associated with increased disease severity (as quantified based on neuromuscular function) at presentation, however, this does not appear a consequence of a greater length of time with symptoms, for example, due to delayed diagnosis. 137 Further, whilst operative treatment on average involves more levels and has an increased occurrence of adverse events, 137 when these factors and baseline severity were controlled for using a propensity matched analysis in the AO Spine observational data, age alone still reduced the extent of recovery. 138 , 139 …”

Establishing the Socio-Economic Impact of Degenerative Cervical Myelopathy Is Fundamental to Improving Outcomes [AO Spine RECODE-DCM Research Priority Number 8]

“… 38 It is noteworthy that while the subject has received significant research attention, the majority of studied cohorts remain young (average ages 60 to 65), and it is not certain whether this data is generalizable to higher age groups, as increasingly seen in higher income countries. 39 It is noteworthy that while a correlated surrogate, age is not necessarily the same as frailty, and this distinction may further need to be considered as this subgroup is addressed. 40 …”

Hospitalisation for degenerative cervical myelopathy in England: insights from the National Health Service Hospital Episode Statistics 2012 to 2019

“…Degenerative cervical myelopathy (DCM) is the most common cause of adult spinal cord dysfunction worldwide, estimated to affect 2% of the adult population [6,[10][11][12]29]. DCM is caused when degenerative, arthritic and/or congenital processes stress and injure the spinal cord [14,24].…”

“…DCM is caused when degenerative, arthritic and/or congenital processes stress and injure the spinal cord [14,24]. This can lead to a range of disabilities, including imbalance and difficulty walking, loss of manual dexterity, sensory loss, bowel or bladder dysfunction, pain and, in extreme circumstances, paralysis [7,12].…”