Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, Nagoya, Japan.
Spine (Phila Pa 1976). 2018 Jun 15;43(12):817-823. doi: 10.1097/BRS.0000000000002446.
A prospective cohort study.
The purpose of this study was to compare the surgical outcomes between nonelderly and elderly patients with cervical spondylotic myelopathy (CSM) and to characterize the preoperative symptoms and postoperative residual symptoms in elderly patients.
Age at the time of surgery influences the surgical outcome. However, no report has elucidated residual symptoms after surgery in elderly patients with CSM. We designed a large-scale cohort study examining the surgical outcomes of CSM in elderly patients from a single surgery.
A total of 1025 consecutive patients with CSM (642 men and 383 women; mean age, 64.4 yr; range, 23-93 yr) who underwent laminoplasty were included. Patients were divided into three groups based on age: nonelderly (<65 yr), young-old (65-74 yr), and old-old (≥75 yr), and the number of patients in each group was 488, 329, and 208, respectively. The pre- and postoperative neurological statuses were evaluated using the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. The recovery rate (RR) of each function was compared among the three groups. Radiographic data including alignment and range of motion were also assessed.
The mean preoperative JOA scores of motor function of the lower extremity in nonelderly, young-old, and old-old groups were 2.8, 2.2, and 1.6, respectively (P < 0.0001). Elderly patients showed significantly lower JOA scores for bladder function than nonelderly patients (2.7, 2.5, and 2.2, P < 0.0001). Cervical lordosis in the neutral position increased gradually with age. Total range of motion decreased with increasing age. After surgery, the mean RRs of motor function of the lower extremity were 57.7%, 38.6%, and 24.0%, respectively. Gait disturbance significantly increased with age (P < 0.0001).
Postoperative gait disturbance persisted more than other symptoms in elderly patients than in nonelderly patients.
一项前瞻性队列研究。
本研究旨在比较非老年和老年颈椎病脊髓病（CSM）患者的手术结果，并描述老年患者的术前症状和术后残留症状。
手术时的年龄会影响手术结果。然而，尚无研究阐明老年 CSM 患者手术后的残留症状。我们设计了一项大规模队列研究，从单一手术中检查了老年 CSM 患者的手术结果。
共纳入 1025 例连续接受颈椎板成形术治疗的 CSM 患者（男 642 例，女 383 例；平均年龄 64.4 岁；范围 23-93 岁）。根据年龄将患者分为三组：非老年（<65 岁）、年轻老年（65-74 岁）和老年（≥75 岁），每组患者分别为 488、329 和 208 例。使用日本矫形协会（JOA）颈椎病评分系统评估术前和术后的神经状态。比较三组患者各功能的恢复率（RR）。还评估了包括对线和活动范围在内的影像学数据。
非老年、年轻老年和老年组患者下肢运动功能的平均术前 JOA 评分分别为 2.8、2.2 和 1.6（P<0.0001）。老年患者的膀胱功能 JOA 评分明显低于非老年患者（2.7、2.5 和 2.2，P<0.0001）。中立位颈椎前凸逐渐随年龄增加而增加。总活动范围随年龄增加而减少。手术后，下肢运动功能的平均 RR 分别为 57.7%、38.6%和 24.0%。步态障碍随年龄增加而显著增加（P<0.0001）。
与非老年患者相比，老年患者术后步态障碍的持续时间长于其他症状。
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