The effects of surgery on locomotion in elderly patients with cervical spondylotic myelopathy

Yoshida, Go; Kanemura, Tokumi; Ishikawa, Yoshimoto; Matsumoto, Akiyuki; Ito, Zenya; Tauchi, Ryoji; Muramoto, Akio; Matsuyama, Yukihiro; Ishiguro, Naoki

doi:10.1007/s00586-013-2961-8

Cited by 23 publications

(20 citation statements)

References 27 publications

(27 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…At present, there are no guidelines for management of degenerative spine diseases in elderly individuals. Moreover, only a few articles have addressed this topic so far, returning partially discrepant results in functional outcomes [10][11][12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

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

Gembruch

Jabbarli

Rashidi

et al. 2019

JCM

View full text Add to dashboard Cite

Background: Degenerative cervical myelopathy (DCM) is the most common reason for spinal cord disease in elderly patients. This study analyzes the preoperative status and postoperative outcome of higher-aged patients in comparison to young and elderly patients in order to determine the benefit to those patients from DCM surgery. Methods: A retrospective analysis of the clinical data, radiological findings, and operative reports of 411 patients treated surgically between 2007 and 2016 suffering from DCM was performed. The preoperative and postoperative neurological functions were evaluated using the modified Japanese Orthopedic Association Score (mJOA Score), the postoperative mJOA Score improvement, the neurological recovery rate (NRR) of the mJOA Score, and the minimum clinically important difference (MCID). The Charlson Comorbidity Index (CCI) was used to evaluate the impact of comorbidities on the preoperative and postoperative mJOA Score. The comparisons were performed between the following age groups: G1: ≤50 years, G2: 51–70 years, and G3: >70 years. Results: The preoperative and postoperative mJOA Score was significantly lower in G3 than in G2 and G1 (p < 0.0001). However, the mean mJOA Score’s improvement did not differ significantly (p = 0.81) between those groups six months after surgery (G1: 1.99 ± 1.04, G2: 2.01 ± 1.04, G: 2.00 ± 0.91). Furthermore, the MCID showed a significant improvement in every age-group. The CCI was evaluated for each age-group, showing a statistically significant group effect (p < 0.0001). Analysis of variance revealed a significant group effect on the delay (weeks) between symptom onset and surgery (p = 0.003). The duration of the stay at the hospital did differ significantly between the age groups (p < 0.0001). Conclusion: Preoperative and postoperative mJOA Scores, but not the extent of postoperative improvement, are affected by the patients’ age. Therefore, patients should be considered for DCM surgery regardless of their age.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Gembruch

Jabbarli

Rashidi

et al. 2019

JCM

View full text Add to dashboard Cite

show abstract

“…32 Yoshida et al evaluated 76 patients older than 75 years and noted that the expansive laminoplasty improved ambulation in the elderly population and reduced nursing care requirements based on JOA and FIM (functional independence measure) scoring. 51…”

Section: Discussionmentioning

confidence: 99%

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

Madhavan¹,

Chieng²,

Foong³

et al. 2016

FOC

View full text Add to dashboard Cite

OBJECTIVE 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. METHODS 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. RESULTS 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 < 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 < 0.00001), therefore demonstrating a higher recovery rate from surgeries (MD −11.98, 95% CI −16.16 to −7.79; p < 0.00001). The length of stay (MD 4.14, 95% CI 3.54–4.73; p < 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. CONCLUSIONS 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.

show abstract

“…Of these disorders, cervical spondylotic myelopathy (CSM) is a serious neurological disease that affects a broad range of people [1].…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment for cervical spondylotic myelopathy in elderly patients: A retrospective study

Chen

Liu

Zhong

et al. 2015

Clinical Neurology and Neurosurgery

View full text Add to dashboard Cite

The effects of surgery on locomotion in elderly patients with cervical spondylotic myelopathy

Cited by 23 publications

References 27 publications

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

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

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

Surgical treatment for cervical spondylotic myelopathy in elderly patients: A retrospective study

Contact Info

Product

Resources

About