Deterioration of surgical outcomes with aging in patients with cervical spondylotic myelopathy

: A retrospective investigation.

: To clarify at which age and at what point in the postoperative period neurological deterioration occurs in patients with cervical spondylotic myelopathy.

: Inferior surgical outcomes tend to be seen with increasing age, however, the age threshold and the postoperative period associated with deterioration have not been established.

: Of 273 patients who underwent laminoplasty, 75 were enrolled in our study who met the criteria of having cervical spondylotic myelopathy, being monitored for a minimum of 2 years after surgery, and experiencing no morbidities within 2 years after surgery. Participants were classified into 4 age groups: group A, 54 years or below (n=12); group B, 55-64 years (n=22); group C, 65-74 years (n=24); and group D, 75 years or above (n=17). Preoperative physical status scores, using the American Society of Anesthesiologists (ASA) classification system, and neurological recovery, indicated by Japanese Orthopaedic Association (JOA) scores, were compared and surgical complications were reviewed.

: The ASA physical status score was significantly lower in group A (1.4±0.5) than in group C (2.0±0.5) or group D (2.2±0.4) (P<0.0083). No difference was seen between the preoperative and 1-year postoperative JOA scores between the groups. However, the JOA score at ≥2 years after surgery was significantly lower in group D (12.9±2.0) than in group A (15.2±1.4; P<0.0083). Major complications of cardiopulmonary disorders were documented only in patients in groups C and D with A higher ASA scores.

: Inferior surgical outcomes were seen in patients 75 years of age or above at 2 years after surgery compared with patients of 54 years or below of age. These clinical features could be reasonably explained by the patients' preexisting physical status related to age.