We investigated clinical features and surgical outcomes for compressive cervical myelopathy in patients over 75 years of age.

Twenty-one patients who underwent surgical decompression for cervical myelopathy were reviewed. The average age at the time of operation was 78.0 years and the mean follow-up period was 5.7 years. Posterior decompression in 19 patients and anterior decompression in 2 patients were performed. Neurologic deficits before and after surgery were assessed using a scoring system by the Japanese Orthopaedic Association (JOA score). Radiological features were examined with radiographs and MRI. The clinical results were compared to those of 24 control patients who were less than 65 years of age at the time of surgery. The average age was 50.2 years and the mean follow-up period was 4.5 years.

In the aged patients, the preoperative mean JOA score was 6.2. Radiological examination revealed that the spinal cord was multisegmentally impinged. The postoperative maximum JOA score averaged 11.1, and the recovery rate was 45.4%. All patients became ambulatory and independent in fundamental daily activities following surgery. Maximum recovery was obtained from 1 to 3 years after the operation and function was maintained for at least 3 years. At the final follow up, the mean JOA score had been reduced to 9.5 and the recovery rate to 27.4%. Only the preoperative duration of symptoms correlated with the outcomes. The pre-operative JOA score in the control patients was 6.5. The postoperative maximum JOA score was 13.8 and the recovery rate was 69.4%. This was not significantly changed at the final follow-up.

Although postoperative recovery of function was significantly inferior to that of the control patients, surgical treatment appears to be beneficial, even in patients over 75 years of age, in improving neurological function and ability of activities in daily living.

Summary: Twenty six consecutive patients with CSM were operated between Jan 2001–Dec 2004 with anterior corpectomy and reconstruction using strut graft/ lordotic cage and stabilization ACP. 10/26 were wheel chair bound/bought on stretcher. 16/26 had spastic lower limbs with myelopathic hands. Post operatively 20/26 had good gait improvement and are community ambulators. 3/26 house hold ambulators and 1 died. 18/26 had good improvement in hand function.

Introduction: Cervical spondylotic myelopathy is a degenerative disease of old age. Patients present with severe disabiling symptoms of spastic gait/inability to walk and varied involvement in the hand. The degenerative spondylosis being the commonest cause, CSM is also caused by OPLL and soft disc herniation.

Methods: 26 consecutive patients who had undergone anterior decompression and reconstruction were evaluated for recovery. The gait pattern, hand functions and return to activities were evaluated pre and postoperatively. No specific scoring system could be used in our studies due to practical reasons.

Results: 18/26 patients had CSM, 5/26 had OPLL and 3/26 soft disc herniations. Soft disc herniation were at 2 levels and all underwent discectomy, tricortical bone grafting and stabilization with ACP. Other patients had corpectomy 1 level – 4, 2 levels – 9, 3 levels – 4, 4 levels – 1. OPLL was removed in 4/5 patients. Xx/10 patients who were wheel chair bound preoperatively became ambulatory, 3/10 had decrease in spasm but still could not walk postoperatively. At 1 year follow up 9/10 patients had good gait pattern and 1 was still wheel chair bound. 18/26 had good hand function recovery with improvement in hand writing, 16/26 returned to previous activity, 1 patient expired.

Conclusion: Anterior decompression for CSN is an effective surgical option. It not only prevents further detoriation, but also improvement is seen in most of the patients.

Significance: Anterior decompression is indicated for all patients with CSM, OPLL and disc herniation as the pathology is anterior based.

Aims

In this prospective observational study, we investigated the time-dependent changes and correlations of upper arm performance tests (ten-second test and Simple Test for Evaluating Hand Function (STEF), the Japanese Orthopaedic Association (JOA) score, and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) in 31 patients with cervical myelopathy who had undergone surgery.