Takeda Hiroki, Michikawa Takehiro, Nagai Sota, Akaike Yuki, Imai Takaya, Kawabata Soya, Ito Kei, Ikeda Daiki, Kaneko Shinjiro, Fujita Nobuyuki
Department of Spine and Spinal Cord Surgery, School of Medicine, Fujita Health University, Aichi, Japan.
Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan.
J Orthop Sci. 2025 May;30(3):554-559. doi: 10.1016/j.jos.2024.07.003. Epub 2024 Jul 16.
The management of degenerative cervical myelopathy (DCM), which often impairs lower extremity function and increases the risk of falls, is gaining recognition for its importance in an aging society. Despite the significant overlap between frailty and locomotive syndrome (LS) in older adults, their interaction in older DCM patients remains unclear. We aimed to determine the characteristics of older DCM patients with frailty, focusing on the association between frailty and LS.
We retrospectively examined the clinical records and imaging data of consecutive patients aged 65 years and above who underwent surgery for DCM at a single facility. Frailty and LS stage were diagnosed using the modified frailty index-11 and the 25-question Geriatric Locomotive Function Scale (GLFS-25), respectively.
A total of 114 subjects were analyzed, among whom approximately 30% were diagnosed with frailty. DCM patients with frailty had significantly worse Japanese Orthopaedic Association Cervical Myelopathy Assessment Questionnaire (JOACMEQ) and GLFS-25 scores at baseline than did those without frailty. Moreover, DCM patients with frailty had significantly more advanced LS stage at baseline than did those without frailty. Meanwhile, no significant difference in the improvement in JOACMEQ and GLFS-25 scores were observed between those with and without frailty after surgery. More precisely, DCM patients with frailty experienced better improvement in lower extremity function based on the JOACMEQ than did those without frailty.
Our results demonstrated that older DCM patients had favorable outcomes following surgery regardless of frailty. Despite the significant association between frailty and LS in DCM patients, frailty did not negatively impact the improvement in LS in older DCM patients. These findings provide valuable information for both older DCM patients and their attending physicians that would help guide decisions about cervical spine surgery for DCM.
退行性颈椎脊髓病（DCM）的管理在老龄化社会中日益受到重视，因为它常常损害下肢功能并增加跌倒风险。尽管老年人中衰弱与运动机能综合征（LS）之间存在显著重叠，但它们在老年DCM患者中的相互作用仍不清楚。我们旨在确定伴有衰弱的老年DCM患者的特征，重点关注衰弱与LS之间的关联。
我们回顾性研究了在单一机构接受DCM手术的65岁及以上连续患者的临床记录和影像数据。分别使用改良衰弱指数-11和25项老年运动机能功能量表（GLFS-25）诊断衰弱和LS分期。
共分析了114名受试者，其中约30%被诊断为衰弱。伴有衰弱的DCM患者在基线时的日本骨科协会颈椎脊髓病评估问卷（JOACMEQ）和GLFS-25评分显著低于无衰弱的患者。此外，伴有衰弱的DCM患者在基线时的LS分期明显比无衰弱的患者更严重。同时，手术后有衰弱和无衰弱患者在JOACMEQ和GLFS-25评分改善方面无显著差异。更确切地说，基于JOACMEQ，伴有衰弱的DCM患者下肢功能改善情况比无衰弱的患者更好。
我们的结果表明，无论是否存在衰弱，老年DCM患者术后都有良好的预后。尽管DCM患者中衰弱与LS之间存在显著关联，但衰弱并未对老年DCM患者的LS改善产生负面影响。这些发现为老年DCM患者及其主治医生提供了有价值的信息，有助于指导DCM颈椎手术的决策。
