gms | German Medical Science

Objective: Elderly patients performed worse in preoperative neurological scores compared to younger patients. Nevertheless their condition improved considerably after surgical treatment. Thus a surgical treatment of elderly patients suffering from CSM should be considered.

Methods: Clinical and radiological data of patients suffering from CSM treated in our clinic between 2011 and 2016 were analyzed retrospectively. Inclusion criteria was T2- weighted MRI-Scans of the cervical spine revealing a hyper intensive sign of myelopathy, caused by a spinal stenosis or a herniated disk. Surgical treatment was performed ventrally or dorsally. The pre- and postoperative (preop, postop) neurological functions were evaluated using the modified Japanese Orthopaedic Association Score (mJOA) and the neural recovery rate and compared between different age groups (G1: age 30-50 years, G2: age 51-70 years and G3: ≥ 71 years). mJOA scores were compared by Friedman’s ANOVA for non-normal distributed data.

Results: 215 patients (142 males; mean age: 63.32 ± 11.98 years) were included. G1 showed a median mJOA preop of 14.93 ± 2.60, postop mJOA was 15.25 ± 2.71 and the mJOA 3 months after surgery was 15.00 ± 2.81. Preop mJOA in G2 was 14.83 ± 3.13, postop mJOA was 15.16 ± 3.08. mJOA 3 months after surgery was 15.87 ± 2.13. In G3, preop mJOA was 13.60 ± 3.12 compared to a postop mJOA of 14.00 ± 3.04 and a mJOA 3 months after surgery of 15.27 ± 2.30. Postop mJOA improved significantly in total. Additionally, pre- and postoperative mJOA differed significantly between the age groups (p=0.005 and p=0.003), but there was no significant difference between the mJOA of the age groups 3 months after surgery (p=0.340). Analyzing the neurological outcome of different age groups showed that elderly patients (G3) have a significant lower preop mJOA and a subsequent lower postop mJOA compared to the other patients (G1 or G2), but they show a higher percental recover rate of mJOA.

Conclusion: The cervical spondylotic myelopathy (CSM) is an age-dependent, ongoing degenerative disease of the cervical spine. It is the most common degenerative disease of the cervical spine in elderly patients. The variable presentation of the CSM is an expression of the complex interaction of mechanic and vascular factors. In this study, we evaluated the postoperative outcome of patients, who were treated surgically due to the CSM.