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Original Research
The Effect of Age on the Benefits of Early Decompression for Cervical Spondylotic Myelopathy
Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.
Dr. Kusin is an Orthopedic Surgery Resident, University of Nebraska Medical Center, Omaha, Nebraska. Dr. NU Ahn is an Associate Professor of Orthopedics, Case Western Reserve School of Medicine, Department of Orthopaedic Surgery, University Hospitals Case Medical Center, Cleveland, Ohio. Dr. UM Ahn is in private practice, New Hampshire NeuroSpine Institute, Bedford, New Hampshire.
Address correspondence to: David Kusin, MD, Department of Orthopedics, University of Nebraska Medical Center, 4400 Emile Street, Omaha, NE 68105 (tel, 402-559-8000; fax, 402-559-5511; email, David.kusin@unmc.edu).
David J. Kusin, MD Uri M. Ahn, MD Nicholas U. Ahn, MD . The Effect of Age on the Benefits of Early Decompression for Cervical Spondylotic Myelopathy. Am J Orthop. September 20, 2018
TAKE-HOME POINTS
Decompression of cervical myelopathy within 24 months of symptom onset results in greater functional improvement compared to delayed decompression.
The improvement with respect to time is more significant for patients older than 65 years compared to younger patients.
Duration of symptoms does not seem to influence the severity of the preoperative Nurick score.
Preoperative severity of symptoms is related to postoperative outcomes.
Other significant predictors of worse outcomes include tobacco use, diabetes, and number of levels fused.
References
ABSTRACT
Cervical myelopathy is the most common cause of acquired spinal cord dysfunction in people aged >55 years. Advanced age and duration of symptoms have been implicated in the literature as negative prognostic indicators for postoperative functional improvement, but very few studies have evaluated the interaction of these factors. We retrospectively reviewed 125 patients who underwent surgery for cervical myelopathy. Patients were stratified according to age greater or less than 65 years and duration of symptoms of greater or less than 12 and 24 months. Functional outcomes were assessed using the Nurick score. Simple regression and multiple regression analyses were done, controlling for sex, preoperative Nurick score, surgical approach, smoking status, diabetes status, prior surgery, number of levels fused, ethanol use, and signal change on preoperative magnetic resonance imaging. The average change in Nurick score in all patients was 1.36, with a significant difference between patients with symptoms for <24 months and those with symptoms for >24 months (1.54 vs 0.98, P = .03). Multiple regression analysis revealed that older patients had a significant difference at 24 months (1.69 vs 1.25, P = .01), whereas younger patients showed slightly lower improvement overall and a change in Nurick score at both thresholds that was statistically nonsignificant.
