SURGICAL OUTCOMES OF COMPRESSIVE CERVICAL MYELOPATHY IN PATIENTS OVER 75 YEARS OF AGE

Abstract

We investigated clinical features and surgical outcomes for compressive cervical myelopathy in patients over 75 years of age.

Twenty-one patients who underwent surgical decompression for cervical myelopathy were reviewed. The average age at the time of operation was 78.0 years and the mean follow-up period was 5.7 years. Posterior decompression in 19 patients and anterior decompression in 2 patients were performed. Neurologic deficits before and after surgery were assessed using a scoring system by the Japanese Orthopaedic Association (JOA score). Radiological features were examined with radiographs and MRI. The clinical results were compared to those of 24 control patients who were less than 65 years of age at the time of surgery. The average age was 50.2 years and the mean follow-up period was 4.5 years.

In the aged patients, the preoperative mean JOA score was 6.2. Radiological examination revealed that the spinal cord was multisegmentally impinged. The postoperative maximum JOA score averaged 11.1, and the recovery rate was 45.4%. All patients became ambulatory and independent in fundamental daily activities following surgery. Maximum recovery was obtained from 1 to 3 years after the operation and function was maintained for at least 3 years. At the final follow up, the mean JOA score had been reduced to 9.5 and the recovery rate to 27.4%. Only the preoperative duration of symptoms correlated with the outcomes. The pre-operative JOA score in the control patients was 6.5. The postoperative maximum JOA score was 13.8 and the recovery rate was 69.4%. This was not significantly changed at the final follow-up.

Although postoperative recovery of function was significantly inferior to that of the control patients, surgical treatment appears to be beneficial, even in patients over 75 years of age, in improving neurological function and ability of activities in daily living.