2022 Volume 13 Issue 1 Pages 12-19
Introduction: The study aimed to assess the association of frailty with long-term results of cervical laminoplasty (LP) for the treatment of cervical spondylotic myelopathy (CSM) and ossification of posterior longitudinal ligament (OPLL).
Methods: We retrospectively reviewed 103 cases (73 men, 30 women, mean age 61.0 y.o., 78 CSMs and 25 OPLLs) who underwent cervical LP and followed-up for over 10 years (mean 12.0 y.o.). For evaluation of frailty, we used a 5-item modified frailty index (mFI-5). Clinical outcomes were assessed by Japanese Orthopaedic Association (JOA) scores and its recovery rate (RR) was evaluated at 1-year postsurgery and final follow-up (over 10 years postsurgery). These outcomes were compared among three groups: preoperative mFI-5 = 0 (40 cases) as a healthy group, =1 (34 cases) as a prefrail group, and ≥2 (29 cases) as a frail group.
Results: The JOA scores improved significantly in all groups 1-year postsurgery, whereas the scores deteriorated in the prefrail and frail group during follow-up periods. The 1-year RR showed significant differences between each group, whereas only the healthy group maintained the RR over 10 years. At final follow-up, the healthy group had significantly higher RR than the other groups, while prefrail and frail group decreased the RR from 1 year to final follow-up.
Conclusions: In healthy patients, JOA score improved early postoperatively and was maintained for long periods, whereas in the patients with any frailty, the early improved JOA score was not maintained for long. These results indicate that the patients with general frality could also have fragility in cervical nerve function and resilience. Since frailty had influences on the recovery and long-term maintenance of cervical nerve function, the mFI-5 should be a reliable predictor of surgical outcome for cervical myelopathy.
