The Impact of Older Age on Functional Recovery and Quality of Life Outcomes after Surgical Decompression for Degenerative Cervical Myelopathy: Results from an Ambispective, Propensity-Matched Analysis from the CSM-NA and CSM-I International, Multi-Center Studies.

Jamie R F Wilson,Michael G Fehlings,Jefferson R Wilson,Alexander R Vaccaro,Jetan H Badhiwala,Branko Kopjar,Fan Jiang

doi:10.3390/jcm8101708

Abstract

Background: The effect on functional and quality of life (QOL) outcomes of surgery in elderly degenerative cervical myelopathy (DCM) patients has not been definitively established. Objective: To evaluate the effect of older age on the functional and QOL outcomes after surgery in an international, multi-center cohort of patients with DCM. Methods: 107 patients aged over 70 years old (mean 75.6 ± 4.4 years) were enrolled in the AOSpine CSM-North America and International studies. A propensity-matched cohort of 107 patients was generated from the remaining 650 adults aged <70 years old (mean 56.3 ± 9.6 years), matched to gender, complexity of surgery, co-morbidities, and baseline functional impairment (modified Japanese Orthopedic Association scale (mJOA). Functional, disability, and QOL outcomes were compared at baseline and at two years post-operatively, along with peri-operative adverse events. Results: Both cohorts were equivalently matched. At two years, both cohorts showed significant functional improvement from the baseline but the magnitude was greater in the younger cohort (mJOA 3.8 (3.2–4.4) vs. 2.6 (2.0–3.3); p = 0.007). This difference between groups was also observed in the SF-36 physical component summary (PCS) and mental component summary (MCS) outcomes (p = <0.001, p = 0.007), but not present in the neck disability index (NDI) scores (p = 0.094). Adverse events were non-significantly higher in the elderly cohort (22.4% vs. 15%; p = 0.161). Conclusions: Elderly patients showed an improvement in functional and QOL outcomes after surgery for DCM, but the magnitude of improvement was less when compared to the matched younger adult cohort. An age over 70 was not associated with an increased risk of adverse events.

Highlights

Degenerative cervical myelopathy (DCM) is a family of non-traumatic spinal cord injuries that contribute to spinal cord compression and the progressive onset of neurological deficits [1,2]
DCM encompasses a number of related conditions such as cervical spondylotic myelopathy (CSM), ossification of the posterior longitudinal ligament (OPLL), ossification of the ligamentum flavum, degenerative disc disease, and various congenital malformations that cause stenosis or instability leading to eventual spinal cord dysfunction [2]
All patients in this study demonstrated improved functional impairment two years after surgery, but the magnitude of improvement seen was greater in the younger cohort, even when baseline functional impairment and age-related risk factors were adjusted for

Summary

Introduction

Degenerative cervical myelopathy (DCM) is a family of non-traumatic spinal cord injuries that contribute to spinal cord compression and the progressive onset of neurological deficits [1,2]. DCM encompasses a number of related conditions such as cervical spondylotic myelopathy (CSM), ossification of the posterior longitudinal ligament (OPLL), ossification of the ligamentum flavum, degenerative disc disease, and various congenital malformations that cause stenosis or instability leading to eventual spinal cord dysfunction [2]. It is the commonest form of spinal cord dysfunction in adults [3], and has become an increasingly important area of focus for spine surgeons and clinician scientists in recent years [4,5,6,7,8,9]. An age over 70 was not associated with an increased risk of adverse events

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