Recovery rates lower and postoperative residual symptoms significantly worsen with age for cervical spondylotic myelopathy patients

Age at time of surgery influences the surgical outcome

Postoperative gait disturbance significantly increases with age, persisting in elderly patients for longer than in non-elderly patients. This is the finding of a recent study comparing clinical and radiographic outcomes between elderly and non-elderly patients with cervical spondylotic myelopathy undergoing laminoplasty. The study was initially published in Spine.

The prospective cohort study characterised both the preoperative symptoms and postoperative residual symptoms of 1,025 cervical spondylotic myelopathy patients from a single surgical centre. There were 642 men and 383 women in the study; mean patient age was 64.4 years, ranging from 23 to 93 years old. Patients were divided into three groups based on age: non-elderly (<65 years old), young-old (65–74 years old), and old-old (≥75 years of age). There were 488, 329, and 208 individuals in each group, respectively.

The mean preoperative Japanese Orthopaedic Association (JOA) scores of motor function of the lower extremity were greatest in the non-elderly, and lowest in the elderly (2.8 and 1.6, respectively; P<0.0001). Elderly patients also had significantly lower JOA scores for bladder function than non-elderly function (2.7 vs. 2.5, P<0.0001).

First author Masaaki Machino (Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan) and colleagues also found that cervical lordosis in the neutral position increased gradually with age for their patient cohort. Total range of motion also decreased with increasing age.

After surgery, the mean recovery rates of motor function of the lower extremity were 57.7%, 38.6%, and 24.0% for the non-elderly, young-old, and old-old, respectively. Gait disturbance was the only trait measure to significantly increase with age (P<0.0001).

These results evidence that age at the time of surgery influence the surgical outcome. Previous to this study, presenting level two evidence, there were no reports in the published literature characterising and analysing residual, postoperative symptoms in elderly patients with cervical spondylotic myelopathy.

In a previous study, it was found that non-caucasian race and non-private medical insurance are independently predictive of receiving posterior-only approaches in the USA. Posterior-only approaches in the treatment of cervical spondylotic myelopathy has been associated in the recent literature with increased mortality, indicating that in this way patient demographics may significantly increase the risk of mortality in the treatment of this condition.


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