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Observational Study
. 2022 Sep;164(9):2317-2326.
doi: 10.1007/s00701-022-05282-y. Epub 2022 Jul 19.

Surgery for degenerative cervical myelopathy in the elderly: a nationwide registry-based observational study with patient-reported outcomes

Tonje Okkenhaug Johansen  1   2 , Vetle Vangen-Lønne  3   4 , Siril T Holmberg  3   4 , Øyvind O Salvesen  5 , Tore K Solberg  6   7 , Agnete M Gulati  8 , Øystein P Nygaard  3   4   9 , Sasha Gulati  3   4
Affiliations
Observational Study

Surgery for degenerative cervical myelopathy in the elderly: a nationwide registry-based observational study with patient-reported outcomes

Tonje Okkenhaug Johansen et al. Acta Neurochir (Wien). 2022 Sep.

Abstract

Background: The aim of this study was to investigate whether clinical outcomes in patients aged ≥ 70 undergoing decompressive surgery for degenerative cervical myelopathy (DCM) differ from those of younger patients (50-70 years) at 1 year.

Methods: Data were obtained from the Norwegian Registry for Spine Surgery (NORspine). Among 651 patients included, 177 (27.2%) were ≥ 70 years old. The primary outcome was change in the Neck Disability Index (NDI). Secondary outcomes were changes in the European Myelopathy Score (EMS), quality of life (EuroQoL EQ-5D), numeric rating scales (NRS) for headache, neck pain, and arm pain, and complications.

Results: Significant improvements in all patient-reported outcomes (PROMs) were detected for both age cohorts at 1 year. For the two age cohorts combined, there was a statistically significant improvement in the NDI score (mean 9.2, 95% CI 7.7 to 10.6, P < 0.001). There were no differences between age cohorts in mean change of NDI (- 8.9 vs. - 10.1, P = 0.48), EQ-5D (0.13 vs. 0.17, P = 0.37), or NRS pain scores, but elderly patients experienced a larger improvement in EMS (0.7 vs. 1.3, P = 0.02). A total of 74 patients (15.6%) in the younger cohort and 43 patients (24.3%) in the older cohort experienced complications or adverse effects within 3 months of surgery, mainly urinary and respiratory tract infections.

Conclusion: Surgery for DCM was associated with significant improvement across a wide range of PROMs for both younger and elderly patients. Surgery for DCM should not be denied based on age alone.

Keywords: Cervical spondylotic myelopathy (CSM); Degenerative cervical myelopathy (DCM); European Myelopathy Score (EMS); Myelopathy in the elderly; Neck Disability Index (NDI); Surgery.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patients’ global perceived effect of surgery
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References

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