The Feature of Clinical and Radiographic Outcomes in Elderly Patients With Cervical Spondylotic Myelopathy: A Prospective Cohort Study on 1025 Patients.

Abstract

A prospective cohort study. The purpose of this study was to compare the surgical outcomes between nonelderly and elderly patients with cervical spondylotic myelopathy (CSM) and to characterize the preoperative symptoms and postoperative residual symptoms in elderly patients. Age at the time of surgery influences the surgical outcome. However, no report has elucidated residual symptoms after surgery in elderly patients with CSM. We designed a large-scale cohort study examining the surgical outcomes of CSM in elderly patients from a single surgery. A total of 1025 consecutive patients with CSM (642 men and 383 women; mean age, 64.4 yr; range, 23-93 yr) who underwent laminoplasty were included. Patients were divided into three groups based on age: nonelderly (<65 yr), young-old (65-74 yr), and old-old (≥75 yr), and the number of patients in each group was 488, 329, and 208, respectively. The pre- and postoperative neurological statuses were evaluated using the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. The recovery rate (RR) of each function was compared among the three groups. Radiographic data including alignment and range of motion were also assessed. The mean preoperative JOA scores of motor function of the lower extremity in nonelderly, young-old, and old-old groups were 2.8, 2.2, and 1.6, respectively (P < 0.0001). Elderly patients showed significantly lower JOA scores for bladder function than nonelderly patients (2.7, 2.5, and 2.2, P < 0.0001). Cervical lordosis in the neutral position increased gradually with age. Total range of motion decreased with increasing age. After surgery, the mean RRs of motor function of the lower extremity were 57.7%, 38.6%, and 24.0%, respectively. Gait disturbance significantly increased with age (P < 0.0001). Postoperative gait disturbance persisted more than other symptoms in elderly patients than in nonelderly patients. 2.