Elsevier

Surgical Neurology

Volume 69, Issue 3, March 2008, Pages 233-240
Surgical Neurology

Spine
Surgical outcomes of elderly patients with cervical spondylotic myelopathy

https://doi.org/10.1016/j.surneu.2007.09.036Get rights and content

Abstract

Background

Cervical spondylotic myelopathy is a potentially serious neurologic disorder that commonly presents with gait difficulty and hand dysfunction. Because the development of CSM is in large part related to advanced spondylosis and degenerative disk disease, elderly patients appear to be at an increased risk to develop this condition. The surgical outcomes of this patient population have been understudied; the authors seek to report their clinical results in a series of patients with CSM older than 75 years who underwent surgical treatment.

Methods

This report is composed of a cohort of 36 elderly patients (older than 75 years) and 34 younger patients (younger than 65 years) who underwent decompressive surgery for CSM at one institution between 2001 and 2005. The patients' functional status was evaluated preoperatively and postoperatively using the mJOA disability scale.

Results

The mean follow-up time in the elderly group was 24 months, with a range from 12 to 48 months. There was a statistically significant improvement between mean preoperative (11.3) and postoperative (14.4) mJOA scores (P < .0001). The younger group had a higher neurologic recovery rate (71%) than the elderly group (59%); however, this was not statistically significant (P = .29). The postoperative complication rate in the elderly population (38%) was higher than in the younger group (6%; P = .002).

Conclusion

Elderly patients with CSM are likely to obtain neurologic improvement after decompressive surgery. Their postoperative complication rate is higher than that of younger patients, yet most complications appear to be self limiting and do not adversely affect neurologic outcome.

Introduction

Cervical spondylotic myelopathy is a potentially devastating neurologic disorder that is commonly presented with gait difficulty and hand dysfunction. The etiology of this condition is multifactorial, and it is believed that compressive, dynamic, and ischemic factors all play a role in its pathophysiology [6], [7], [8], [12], [18]. The natural history of CSM is quite poor because many patients experience progressive neurologic deterioration with impairment of motor function. Consequently, surgical intervention is commonly advocated in the management of this condition [2], [3], [4], [5], [15], [16], [17], [19], [21], [22], [23], [24], [25], [26].

Because the development of CSM is in large part related to advanced spondylosis and degenerative disk disease, elderly patients appear to be at increased risk to develop this condition. The elderly population is the fastest-growing segment of the US population, and many are expecting to maintain their quality of life longer than previous generations [24]. However, some surgeons are reluctant to operate on elderly patients with CSM because of coexisting medical problems, concerns about the lack of neurologic benefit after surgery, and the perceived risk of perioperative complications.

Despite the prevalence of this condition, there has been relatively little information published regarding the surgical outcomes of elderly patients with CSM [9], [11], [14], [19], [20], [22]. In this article, the authors seek to report their clinical results in a series of 36 patients older than 75 years and a comparison cohort of 34 patients younger than 65 years who underwent surgical treatment for symptomatic CSM.

Section snippets

Patient population

A medical record and imaging review was performed to identify the number of patients older than 75 years and younger than 65 years who underwent decompressive surgery for CSM at one institution between 2001 and 2005. Patients who presented primarily with signs and symptoms of radiculopathy or who had solely nerve root compression on MRI were excluded. Patients who presented emergently with an acute change in neurologic function related to central cord syndrome or another traumatic event were

Elderly group

The mean follow-up time was 24 months, with a range from 12 to 48 months. The mean preoperative mJOA score in this series was 11.3 ± 2.4, with a range from 8 to 15. The mean mJOA score postoperatively was 14.4 ± 2.1, with a range of 11 to 17. There was a statistically significant improvement between mean preoperative (11.3 ± 2.4) and postoperative (14.4 ± 2.1) mJOA scores (P < .0001). The mean neurologic recovery rate was 59%, with a range between 0% and 100%. Based on the criteria of Matsuda

Background

Senior citizens (persons aged >65 years) are the fastest-growing segment of the US population, and by the middle of this century, it is predicted that they will represent 23% of the population [24]. In contrast to previous generations, senior citizens are now expecting to maintain an active lifestyle into their later years. The ability to provide appropriate health care for this burgeoning population is one of the most formidable issues facing the field of medicine. The aging of the population

Conclusions

Elderly patients with CSM are likely to achieve neurologic improvement after decompression surgery, resulting in improved ability to perform activities of daily living and maintained functional independence. The postoperative complication rate appears higher in this patient population and is associated with longer hospital stays compared with younger patients. However, most of these complications appear to be self limiting and do not affect neurologic recovery. Thorough preoperative medical

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