Spinal Surgery
Online ISSN : 1880-9359
Print ISSN : 0914-6024
ISSN-L : 0914-6024
Original Articles
Surgical Outcomes in Cervical Spondylotic Myelopathy in Elderly Patients—Changes in Neurological Symptoms, Complications, and the Significance of Surgery—
Saya KohTsuyoshi SasakiYuri KatayamaYohei OnishiHiroki OhataHiroyuki GotoHiromichi IkunoMisao Nishikawa
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2020 Volume 34 Issue 3 Pages 261-271

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Abstract

  Purpose : We evaluated the results of surgical treatments for cervical spondylotic myelopathy in elderly patients (75-90 years old) and pre-elderly patients (65-75 years old).

  Materials and Methods : We examined the Japanese Orthopaedic Association (JOA) score preoperatively, immediately after surgery, and 6 months after surgery, as well as the recovery rate (R.R.) in elderly patients (41 cases) and pre-elderly patients (64 cases). Operative procedures included anterior cervical disectomy and fusion (ACDF) (20 cases), posterior decompression (PD) (46 cases) (laminectomy : 6 cases, open-door laminoplasty : 19 cases, and French-door laminoplasty : 21 cases), and posterior decompression and posterior lateral fixation (39 cases).

  Results : In the elderly patient group, the R.R. in the immediate postoperative period was 67.6%, the R.R. at 6 months after the operation was 60.9%, and the latest R.R. was 73.8%. In the pre-elderly patient group, the R.R. in the immediate postoperative period was 67.2%, the R.R. at 6 months after the operation was 71.9%, and the latest R.R. was 85.0%. In both groups, the R.R. was high. There was no significant difference between the R.R. in both groups in the immediate postoperative period. The R.R. in the pre-elderly patient group increased 6 months later but the R.R. in the elderly patient group decreased at that point. However, at the recent follow-up, the R.R. increased again in both groups. Postoperative complications were transient delirium in 11 cases (10.4%), pneumonia in 2 cases (1.9%), C5 palsy in 2 cases (1.9%), dysphagia in 2 cases (1.9%), displacement of ceramic spacer in 2 cases (1.9%), and postoperative infection in 1 case (0.9%).

  Discussion : Both the elderly and pre-elderly patient groups had good surgical outcomes despite operative procedures. We should perform surgery in patients complaining of neurological symptoms as early as possible while taking care of the general medical condition, and the familial and social backgrounds. We should operate as less invasively as possible and let the patients attempt walking as early as possible to avoid post-operative complications.

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© 2020 by The Japanese Society of Spinal Surgery
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