Notani Naoki, Miyazaki Masashi, Kanezaki Shozo, Ishihara Toshinobu, Tsumura Hiroshi
Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan.
Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan.
Clin Neurol Neurosurg. 2017 Sep;160:78-82. doi: 10.1016/j.clineuro.2017.06.019. Epub 2017 Jul 1.
We aimed to assess the surgical outcomes of laminoplasty for cervical spondylotic myelopathy (CSM) in very elderly patients (older than 80 years), focusing specifically on the time from symptom onset to surgery and on the loss in spinal cord signal intensity on magnetic resonance imaging (MRI).
We retrospectively reviewed 100 consecutive patients (61 males and 39 females) with CSM who underwent laminoplasty between 2006 and 2014. The patients were stratified based on the age at the time of surgery, with Group A consisting of 26 patients aged 80 years or older and Group B consisting of 74 patients younger than 80 years. The severity of myelopathy was assessed in terms of the Japanese Orthopaedic Association (JOA) score. Signal intensity loss on MRI was graded from I to III based on the size of the area with intensity changes (Grade I, one disk; Grade II, larger than one disk) and presence of intramedullary hypointensity on T1-weighted sagittal scans (Grade III). Surgical outcome, morbidities, and changes in spinal cord signal intensity on MRI were analyzed.
The time from symptom onset to surgery was 6.2±5.2 and 16.5±18.8months in Groups A and B, respectively, with significantly shorter duration of symptoms in Group A (p<0.001). Compared to Group B, Group A had lower mean JOA score preoperatively (8.8±1.9 vs. 10.1±1.7) and postoperatively (12.1±1.7 vs. 13.5±1.6), as well as lower mean JOA score recovery rate (40.7±12.5% vs. 51.0±15.4%) (p<0.05 for all). However, there was no difference between the groups regarding achieved JOA score (Group A, 3.3±1.0; Group B, 3.4±1.0). Preoperatively, intramedullary signal intensity change was observed in 84.6% of patients in Group A (22/26; 3, 13, and 6 patients with Grade I, II, and III, respectively), and in (82.4%) of patients in Group B (61/74; 18, 38, and 5 patients with Grade I, II, and , respectively), with significantly higher incidence of Grade III pattern in Group A than in Group B.
Compared to younger patients, very elderly patients had a shorter time from symptom onset to surgery but lower preoperative JOA score, indicating that the condition of very elderly patients is likely to deteriorate and become severe rapidly after the onset of myelopathy. However, it is very important to know these pathologies and optimize the timing of surgery, as laminoplasty for CSM can be beneficial even in very elderly patients.
我们旨在评估80岁以上高龄患者行颈椎管扩大成形术治疗脊髓型颈椎病（CSM）的手术效果，特别关注症状出现至手术的时间以及磁共振成像（MRI）上脊髓信号强度的变化。
我们回顾性分析了2006年至2014年间连续接受颈椎管扩大成形术的100例CSM患者（男61例，女39例）。根据手术时的年龄对患者进行分层，A组由26例年龄80岁及以上的患者组成，B组由74例年龄小于80岁的患者组成。根据日本骨科协会（JOA）评分评估脊髓病的严重程度。根据MRI上信号强度变化区域的大小将信号强度损失分为I至III级（I级，一个椎间盘；II级，大于一个椎间盘），并根据T1加权矢状位扫描上是否存在脊髓内低信号（III级）进行分级。分析手术效果、并发症以及MRI上脊髓信号强度的变化。
A组和B组从症状出现至手术的时间分别为6.2±5.2个月和16.5±18.8个月，A组症状持续时间明显较短（p<0.001）。与B组相比，A组术前平均JOA评分较低（8.8±1.9 vs. 10.1±1.7），术后也较低（12.1±1.7 vs. 13.5±1.6），平均JOA评分恢复率也较低（40.7±12.5% vs. 51.0±15.4%）（所有p<0.05）。然而，两组术后达到的JOA评分无差异（A组，3.3±1.0；B组，3.4±1.0）。术前，A组84.6%的患者（22/26；I级、II级和III级分别为3例、13例和6例）以及B组82.4%的患者（61/74；I级、II级和III级分别为18例、38例和5例）观察到脊髓内信号强度变化，A组III级模式的发生率明显高于B组。
与年轻患者相比，高龄患者从症状出现至手术的时间较短，但术前JOA评分较低，这表明高龄患者脊髓病发病后病情可能迅速恶化并加重。然而，了解这些病理情况并优化手术时机非常重要，因为即使是高龄患者，颈椎管扩大成形术治疗CSM也可能有益。
