Surgical Outcome of Elderly Patients Having Cervical Spondylotic Myelopathy: A Comparative Study Using JOA Scoring

ABSTRACT

Background: Surgical outcome in patients with cervicalspondylotic myelopathy may affects by variety of factors.Different study outcome suggest that the number of symptomsand involved levels, symptom duration and posterior approachsignificantly increased with increasing age, whereaspreoperative Japanese Orthopedic Association scoredecreased among the different age groups.Objective: The goal of this study is to analyze the surgicaloutcome by comparing younger and elderly patient groups onthe basis of preoperative radiological and clinical data.Methods: To find out the surgical outcome the clinical andradiological data of 32 patients who underwent expansivelaminoplasty were reviewed after their surgery had beenperformed. All of the Patients were divided into two groups,group (a) younger patient group (<65 yr of age; n = 13) andan elderly patient group (≥65 yr of age; n = 19). Patients wereassessed by use of the Japanese Orthopaedic Associationscale (JOA) to know the neurological status of them. Computedtomographic myelography and magnetic resonance imagingexamined for radiological feature. Finally, the effects of theclinical and radio-logical findings on neurological outcome wereinvestigated.Results: The scores of preoperative and postoperative meanof (JOA) in elderly patients were significantly lower thanyounger patients. In the elderly patients cases, the transversearea of the spinal cord at the level of maximum compressionand symptom duration were the factors that predicted anexcellent recovery on the other hand the transverse area wasthe only predictor of excellent recovery in younger patients.Intensity change on the spinal cord and age, preoperativeJapanese Orthopaedic Association score, canal diameter werenot predictive in either age range.Conclusion: Both younger and elderly patient groups thetransverse area of the spinal cord may be a reliable predictor ofexcellent recovery. In case of elderly patients shorter symptomduration was an important factor in the excellent recovery.