Study Design. Retrospective clinical review and prospective report of postoperative delirium after cervical spine surgeries.Objective. To investigate factors contributing to the development of delirium after cervical surgery and see whether amended therapeutic protocols could improve or alter postoperative outcomes.Summary of Background Data. Important consequences of postoperative delirium for the orthopedic patients include impaired recovery and increased morbidity and mortality. Although its risk factors have been reported in orthopedic surgery, there are a very few reports regarding postoperative delirium in spine surgery.Methods. Eighty-one cervical myelopathy patients were retrospectively examined about the incidence of postoperative delirium and the risk factors. Similarly, 41 patients who received postoperative care under modified protocols were prospectively examined.Results. Postoperative delirium occurred more commonly in patients over 70 years and those with hearing impairment. Patients who received high-dose methylprednisolone (Ͼ1000 mg) demonstrated an increased incidence of postoperative delirium. Under modified protocol, we reduced the usage of methylprednisolone and encouraged free body movement with cervical orthosis immediately after surgery. The incidence of postoperative delirium was significantly lower under the modified protocol.Conclusion. Early commencement of mobilization after cervical spine surgery would be crucial to the prevention of postoperative delirium in the elderly.Key words: postoperative delirium, cervical spine surgery, hearing impairments, methylprednisolone. Spine 2009;34: 2500-2504Delirium is an acute and relatively sudden decline in attention-focus, perception, and cognition and known to occur usually in the elderly people.1 Its incidence is known to increase during the perioperative period and it can cause major medical management problems. Several previous reviews indicate that delirium may affect a large proportion of orthopedic patients and report prevalence rates of 28% to 61%. 2,3 Although the incidence in hip and knee joint surgery has been widely reported, there are few studies regarding postoperative delirium in spine surgery. 4,5 Increasing age, blood urea levels, cardiothoracic index, hypertension, smoking habits, blood replacement during bypass, atrial fibrillation (AF), pneumonia, and blood fluid balance in the postoperative period were found to be significant risk factors for delirium by logistic regression analysis.6 Previous reports also suggest that prior cognitive impairment and reduced hemoglobin and hematocrit levels are significant risk factors for postoperative delirium. With the development of modern medicine, the percentage of elderly people in the population is increasing and thus the incidence of postoperative delirium would increase. Spinal surgery in general and cervical spinal surgery in particular entail specific management problems and risk factors. During the postoperative phase of cervical spine surgery, it is essential to maintain spina...