Nagashima Hideki, Morio Yasuo, Yamashita Hideki, Yamane Koji, Teshima Ryota
Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan.
Clin Orthop Relat Res. 2006 Mar;444:140-5. doi: 10.1097/01.blo.0000201156.21701.86.
Treatment of cervical myelopathy in elderly patients is controversial. We retrospectively studied 113 patients who had decompression surgery from 1990-2001 to clarify how pre-operative conditions, duration of symptoms, involved levels, surgical outcomes, and complications differ between younger and elderly patients. We also asked whether elderly patients would likely have reasonable outcomes of surgery. The patients were divided into five age groups: Group 1, 36-45 years (12 patients); Group 2, 46-55 years (22 patients); Group 3, 56-65 years (31 patients); Group 4, 66-75 years (32 patients); and Group 5, 76-85 years (16 patients). The duration of symptoms was similar among the five groups. The involved level was more cephalic in the older groups, and the most frequently involved level in patients older than 75 years was C3-C4. Neurologic symptoms were more severe preoperatively and postoperatively in older patients. The recovery ratio also was lower in older patients; however, in Group 5 it was 36.9%, which indicated that patients older than 75 years could regain approximately 40% of their function postoperatively. Decompression surgery can be a reasonable treatment option for cervical myelopathy, even in elderly patients.
Therapeutic Study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.
老年患者颈椎病的治疗存在争议。我们回顾性研究了1990年至2001年期间接受减压手术的113例患者，以阐明年轻患者和老年患者在术前状况、症状持续时间、受累节段、手术结果及并发症方面有何不同。我们还探讨了老年患者手术是否可能取得合理的结果。患者被分为五个年龄组：第1组，36 - 45岁（12例患者）；第2组，46 - 55岁（22例患者）；第3组，56 - 65岁（31例患者）；第4组，66 - 75岁（32例患者）；第5组，76 - 85岁（16例患者）。五组患者的症状持续时间相似。老年组的受累节段更靠上，75岁以上患者最常受累的节段是C3 - C4。老年患者术前和术后的神经症状更严重。老年患者的恢复率也较低；然而，在第5组中恢复率为36.9%，这表明75岁以上的患者术后可恢复约40%的功能。减压手术即使对老年颈椎病患者也可能是一种合理的治疗选择。
治疗性研究，IV级（病例系列）。有关证据水平的完整描述，请参阅作者指南。
