Surgery for cervical myelopathy in geriatric patients

Area of Science:

• Neurosurgery
• Geriatric Medicine
• Spinal Surgery

Background:

• Increasing number of geriatric patients require surgical treatment for cervical myelopathy.
• Limited literature exists on the efficacy and safety of surgical interventions in this demographic.
• Anecdotal evidence suggests positive outcomes, necessitating further investigation.

Purpose of the Study:

• To review surgical outcomes in patients over 70 years old with non-traumatic cervical myelopathy.
• To determine the efficacy of surgical management for this patient group.
• To examine the morbidity associated with surgical procedures in geriatric patients.

Main Methods:

• Retrospective review of 53 cervical surgical procedures in 51 patients (age > 70) between 1987 and 1992.
• Procedures included expansile laminoplasties, anterior cervical discectomy and fusion, and posterior laminectomies.
• Patient outcomes were assessed using Nurick's criteria, comparing pre- and post-operative functional status.

Main Results:

• 60.8% of patients showed improvement in myelopathic symptoms, particularly gait; 33.3% were stabilized; 5.9% worsened.
• The major morbidity rate was 3.9%, and the minor morbidity rate was 5.8%.
• The perioperative mortality rate was 2%, with most complications resolving post-operatively.

Conclusions:

• Surgical correction for significant non-traumatic cervical myelopathy in the geriatric population can be performed safely.
• Acceptable morbidity and a reasonable expectation of clinical improvement support surgical intervention.
• This study provides evidence for the efficacy of surgical management in elderly patients with cervical myelopathy.