Can Elderly Patients Recover Adequately After Laminoplasty? A Comparative Study of 520 Patients With Cervical Spondylotic Myelopathy

Abstract

This was a prospective clinical comparative study of surgical outcomes for patients with cervical spondylotic myelopathy (CSM). The purpose of this study was to compare the surgical outcomes between nonelderly and elderly patients with CSM who underwent laminoplasty. Age at the time of surgery influences the surgical outcome. We designed a large-scale study of the surgical outcome for CSM from a single operative procedure used exclusively in elderly patients. A total of 520 consecutive patients with CSM (331 men; 189 women) who underwent double-door laminoplasty were included. Mean age was 62 years (range, 23-93), and mean duration of disease was 20.1 ± 32.0 months. Average postoperative follow-up period was 33.3 ± 15.7 months. Patients were divided into 3 groups by age: nonelderly (<65 years), young-old (65-74 years), and old-old (≥75 years). The number of patients in each group was 287, 143, and 90. Pre- and postoperative neurological status was evaluated using the Japanese Orthopaedic Association scoring system for cervical myelopathy (JOA score). Mean pre- and postoperative JOA scores in nonelderly, young-old, and old-old groups were 11.0 and 14.4, 10.2 and 13.2, and 8.7 and 11.8 points, respectively. The elderly group showed significantly low recovery rates of JOA scores compared with the nonelderly group (P < 0.0001). However, mean achieved JOA scores (postoperative JOA score - preoperative JOA score) were 3.4, 3.0, and 3.1 in nonelderly, young-old, and old-old groups, respectively, with no significant difference among these groups (P = 0.17). Pre- and postoperative JOA scores were low in elderly patients. However, the achieved JOA score was almost similar among the 3 groups. Thus, elderly patients could obtain reasonable recovery after cervical laminoplasty.