Yoshida Go, Kanemura Tokumi, Ishikawa Yoshimoto, Sakai Yoshihito, Iwase Toshiki, Matsuyama Yukihiro, Ishiguro Naoki
Department of Orthopaedic Surgery, Hamamatsu Medical Center, 328 Tomizuka-cho, Naka-ku, Hamamatsu, Shizuoka 432-8580, Japan.
J Orthop Sci. 2012 Jan;17(1):3-8. doi: 10.1007/s00776-011-0178-4. Epub 2011 Nov 29.
Most elderly patients have cardiopulmonary diseases anamnesis and a perceived risk of perioperative complications. The responsible lesion may be located more cranially in elderly patients with cervical spondylotic myelopathy (CSM) compared with that in younger patients. The study aimed at evaluating cardiopulmonary dysfunction of CSM and effects of surgery on cardiopulmonary function and perioperative complications.
Thirty-one consecutive patients (>75 years of age) who underwent expansive laminoplasty for CSM were compared with 30 age-matched controls who underwent lumbar decompression. The ejection fraction (EF), percent vital capacity (%VC), and forced expiratory volume percent in 1 s (FEV(1)%) before and 6 months after surgery were analyzed by cardiac ultrasonography and spirometry. Furthermore, neurological status, lesion level, and perioperative complications were evaluated.
The mean %VC significantly decreased in the study group compared with that in the control group before surgery (89.4 ± 12.4 vs. 96.5 ± 12.7, P = 0.032). EF, %VC, and FEV(1)% showed no significant differences after surgery. The mean %VC was significantly lower in the cranial group with lesions above C4 compared with that in the caudal group before (81.8 ± 10.0 vs. 95.0 ± 11.2, P = 0.0021) and after (83.8 ± 9.7 vs. 92.1 ± 11.8, P = 0.047) surgery. The Japanese Orthopaedic Association score significantly improved after surgery (P < 0.001), and the mean recovery rate was 48.3%. The occurrence of perioperative complications was significantly higher in the study group compared with that in the control group (P = 0.018).
Elderly CSM patients with cranial lesions have a decreased %VC and high risk of perioperative cardiopulmonary complications. Therefore, detailed perioperative workup and timely decompression should be performed to avoid progression toward fixed neurological deficits and cardiopulmonary dysfunction whether or not they result from myelopathy itself.
