gms | German Medical Science

The surgical outcome in patients with cervical spondylotic myelopathy may be affected by a variety of factors. Among those, age of the patient may play a major role because of a reduced rehabilitation potential. The purpose of this study was to evaluate whether cervical decompression surgery in patients of high age leads to reasonable outcome.

We reviewed the records of 52 patients being at least 75 years of age with cervical spinal stenosis operated upon at our institution. All procedures were performed between 01/1995 and 11/2002.

52 patients (31 male, 21 female) with an average age of 79 years (maximum 87 yrs) underwent a total of 54 operations. According to our regimen in 16 patients with multilevel stenosis we performed canal-expansive laminoplasty, eight patients with bisegmental stenosis were treated with corpectomy and in 30 cases with monosegmental stenosis we performed anterior decompression and fusion in 23 cases, laminectomy in five cases and bilateral interlaminar fenestration in two cases. Three patients (7.6 %) experienced one ore more serious postoperative complications (3 wound infections, one septicemia, one pulmonary embolus). Follow-up was at least 12 months in all patients. Radicular and neck pain was reduced significantly in 24 of 25 patients presenting these symptoms preoperatively. Improvement of a preoperative neurological deficit was seen in 38 of 47 cases whereas 9 patients displayed a stable myelopathy. There was no case of further deterioration during the follow-up period. Among those 9 cases without improvement three patients had diabetes mellitus and four angiopathic diseases. Neurological outcome was significantly better in patients with a short preoperative history.

Surgical treatment of symptomatic cervical stenosis is very effective even in the old age provided there is an appropriate preoperative selection and attentive perioperative care. Diabetes mellitus and angiopathic diseases might be factors predicting unfavorable outcome.