Masayoshi Ishii1, Eiji Wada, Masayuki Hamada. 1. Department of Orthopaedic Surgery, Hoshigaoka Kosei Nenkin Hospital, Hirakata, Osaka, Japan. masa-ishii@umin.ac.jp
Abstract
STUDY DESIGN: : A retrospective investigation. OBJECTIVE: : To clarify at which age and at what point in the postoperative period neurological deterioration occurs in patients with cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA: : Inferior surgical outcomes tend to be seen with increasing age, however, the age threshold and the postoperative period associated with deterioration have not been established. METHODS: : Of 273 patients who underwent laminoplasty, 75 were enrolled in our study who met the criteria of having cervical spondylotic myelopathy, being monitored for a minimum of 2 years after surgery, and experiencing no morbidities within 2 years after surgery. Participants were classified into 4 age groups: group A, 54 years or below (n=12); group B, 55-64 years (n=22); group C, 65-74 years (n=24); and group D, 75 years or above (n=17). Preoperative physical status scores, using the American Society of Anesthesiologists (ASA) classification system, and neurological recovery, indicated by Japanese Orthopaedic Association (JOA) scores, were compared and surgical complications were reviewed. RESULTS: : The ASA physical status score was significantly lower in group A (1.4±0.5) than in group C (2.0±0.5) or group D (2.2±0.4) (P<0.0083). No difference was seen between the preoperative and 1-year postoperative JOA scores between the groups. However, the JOA score at ≥2 years after surgery was significantly lower in group D (12.9±2.0) than in group A (15.2±1.4; P<0.0083). Major complications of cardiopulmonary disorders were documented only in patients in groups C and D with A higher ASA scores. CONCLUSIONS: : Inferior surgical outcomes were seen in patients 75 years of age or above at 2 years after surgery compared with patients of 54 years or below of age. These clinical features could be reasonably explained by the patients' preexisting physical status related to age.
STUDY DESIGN: : A retrospective investigation. OBJECTIVE: : To clarify at which age and at what point in the postoperative period neurological deterioration occurs in patients with cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA: : Inferior surgical outcomes tend to be seen with increasing age, however, the age threshold and the postoperative period associated with deterioration have not been established. METHODS: : Of 273 patients who underwent laminoplasty, 75 were enrolled in our study who met the criteria of having cervical spondylotic myelopathy, being monitored for a minimum of 2 years after surgery, and experiencing no morbidities within 2 years after surgery. Participants were classified into 4 age groups: group A, 54 years or below (n=12); group B, 55-64 years (n=22); group C, 65-74 years (n=24); and group D, 75 years or above (n=17). Preoperative physical status scores, using the American Society of Anesthesiologists (ASA) classification system, and neurological recovery, indicated by Japanese Orthopaedic Association (JOA) scores, were compared and surgical complications were reviewed. RESULTS: : The ASA physical status score was significantly lower in group A (1.4±0.5) than in group C (2.0±0.5) or group D (2.2±0.4) (P<0.0083). No difference was seen between the preoperative and 1-year postoperative JOA scores between the groups. However, the JOA score at ≥2 years after surgery was significantly lower in group D (12.9±2.0) than in group A (15.2±1.4; P<0.0083). Major complications of cardiopulmonary disorders were documented only in patients in groups C and D with A higher ASA scores. CONCLUSIONS: : Inferior surgical outcomes were seen in patients 75 years of age or above at 2 years after surgery compared with patients of 54 years or below of age. These clinical features could be reasonably explained by the patients' preexisting physical status related to age.