Surgical outcomes of elderly patients with cervical spondylotic myelopathy: a meta-analysis of studies reporting on 2868 patients

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Cervical spondylotic myelopathy usually presents in the 5th decade of life or later but can also present earlier in patients with congenital spinal stenosis. As life expectancy continues to increase in the United States, the preconceived reluctance toward operating on the elderly population based on older publications must be rethought. It is a known fact that outcomes in the elderly cannot be as robust as those in the younger population. There are no publications with detailed meta-analyses to determine an acceptable level of outcome in this population. In this review, the authors compare elderly patients older than 75 years to a nonelderly population, and they discuss some of the relevant strategies to minimize complications.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors performed a PubMed database search to identify English-language literature published between 1995 and 2015. Combinations of the following phrases that describe the age group (“elderly,” “non-elderly,” “old,” “age”) and the disease of interest as well as management (“surgical outcome,” “surgery,” “cervical spondylotic myelopathy,” “cervical degenerative myelopathy”) were constructed when searching for relevant articles. Two reviewers independently assessed the outcomes, and any disagreement was discussed with the first author until it was resolved. A random-effects model was applied to assess pooled data due to high heterogeneity between studies. The mean difference (MD) and odds ratio were calculated for continuous and dichromatic parameters, respectively.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Eighteen studies comprising elderly (n = 1169) and nonelderly (n = 1699) patients who received surgical treatment for cervical spondylotic myelopathy were included in this meta-analysis. Of these studies, 5 were prospective and 13 were retrospective. Intraoperatively, both groups required a similar amount of operation time (p = 0.35). The elderly group had lower Japanese Orthopaedic Association (JOA) scores (MD −1.36, 95% CI −1.62 to −1.09; p &lt; 0.00001) to begin with compared with the nonelderly group. The nonelderly group also had a higher postoperative JOA score (MD −1.11, 95% CI −1.44 to −0.79; p &lt; 0.00001), therefore demonstrating a higher recovery rate from surgeries (MD −11.98, 95% CI −16.16 to −7.79; p &lt; 0.00001). The length of stay (MD 4.14, 95% CI 3.54–4.73; p &lt; 0.00001) was slightly longer in the elderly group. In terms of radiological outcomes, the elderly group had a smaller postoperative Cobb angle but a greater increase in spinal canal diameter compared with the nonelderly group. The complication rates were not significant.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Cervical myelopathy is a disease of the elderly, and age is an independent factor for recovery from surgery. Postoperative and long-term outcomes have been remarkable in terms of improvement in mobility and independence requiring reduced nursing care. There is definitely a higher potential risk while operating on the elderly population, but no significant difference in the incidence of postoperative complications was noted. Withholding surgery from the elderly population can lead to increased morbidity due to rapid progression of symptoms in addition to deconditioning from lack of mobility and independence. Reduction in operative time under anesthesia, lower blood loss, and perioperative fluid management have been shown to minimize the complication rate. The authors request that neurosurgeons weigh the potential benefit against the risks for every patient before withholding surgery from elderly patients.</jats:p></jats:sec>

Degenerative Cervical Myelopathy in Higher-Aged Patients: How Do They Benefit from Surgery?

“…But postoperative and long-term improvements in old patients have been remarkable in terms of improvements in mobility and independence, leading to reduced nursing care being required. The incidence of postoperative complications did not show a significant difference [24].…”

Transdural approach to resection of retro-odontoid cysts in elderly patients: report of 3 cases

“…Elderly patients deteriorate rather quickly from deconditioning if they are immobilized because of progressive and untreated cervical myelopathy. 37,54 In addition, from our institutional experience and that described in the literature, we have noted high complication rates in elderly patients who undergo a transnasal endoscopic or transoral procedure. 25 To date, Menezes and colleagues 15 have published the largest case series of surgical experience with patients with retro-odontoid pseudogout.…”

Analysis of compliance and efficacy of integrated management of whole process in the choice of percutaneous full-endoscopic surgery for patients with cervical disc herniation

“…During hospitalization and after discharge, guided interventions involving the patient's functional exercise of the cervical spine can help to achieve signi cant clinical effectiveness [21,23] . After discharge, the patient's compliance decreases or disappears, and the early relief of symptoms can cause the patient to forget that good work and life habits are the basis for maintaining the normal function of the cervical spine [24] . Some patients gradually neglect good behavioral habits and cervical functional exercise, leading to the recurrence of disease symptoms or adjacent segment disc herniation.…”

“…An integrated management model of the whole course enables CDH patients to receive percutaneous endoscopic treatment and obtain effects consistent with the classical surgical procedure while avoiding or signi cantly reducing the complications associated with that approach; it also improves the patient compliance rate, signi cantly reduces the length of hospital stay, and reduces the recurrence rate of symptoms [32][33][34] . Through the integrated management of the whole course, we can promote the consistency of medical and health education, improve the compliance of CDH patients so that they actively cooperate with the treatment, cultivate and maintain good living and work habits, and strengthen awareness of maintaining the health of the cervical spine [3,14,24]. The establishment of this new health education model of medical cooperation strengthens the sense of responsibility, makes the personnel in each management group be invested and actively participate, ensures the safety of medical treatment and nursing, avoids the occurrence of medical errors and accidents, and improves the satisfaction of clinicians and patients with nursing work [25,26].It also promotes the development of new medical technology, effectively reduces the average length of hospital stay and speeds up the turnover rate of hospital beds.…”