Cervical myelopathy in elderly patients: clinical results and MRI findings before and after decompression surgery

We examined 173 patients with cervical myelopathy of various causes. Seventy-seven patients underwent anterior decompression and fusion at not more than two levels, while 96 underwent posterior decompression by an expansive laminoplasty. Patients were followed up for between one and 4 1/2 years and the outcome was assessed both from a functional and a radiological point of view. The functional assessment used was according to the Japanese Orthopaedic Association (JOA) score (the higher the better), and the imaging outcome was assessed by a midline sagittal MRI assigned to three categories either for restoration of cord morphology, improvement or unchanged. Patients were divided into two groups: those 65 years old and older (50 patients), and those younger than 65 years old (123 patients). The data allowed the following conclusions to be reached: Older patients were likely to have more levels, and higher levels affected, and as a result were more likely to require a posterior operation. The recovery rate after an anterior operation was the same as that after a posterior operation. The pre- and post-operative JOA scores were higher in younger patients who tended to have milder disease with fewer levels affected. Younger patients had better morphological restoration. The recovery was likely to be better if the postoperative morphology was better. The morphology postoperatively was likely to be better if there had been less compression preoperatively. If the morphology was restored the disease duration was likely to have been less. The patients did better if the cord morphology was restored to normal, and this was easier to achieve in younger patients who had fewer levels involved and had less cord distortion preoperatively.