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The effects of surgery on locomotion in elderly patients with cervical spondylotic myelopathy

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Abstract

Purpose

This study aimed to evaluate the effects of surgery on locomotor ability in patients with cervical spondylotic myelopathy (CSM) and compare the results between elderly and younger patients.

Methods

A total of 369 consecutive patients who underwent expansive laminoplasty for CSM were prospectively analysed. Patients were divided into two age groups of ≥75 years (elderly group, 76 patients) and <75 years (younger group, 293 patients). Locomotor ability was estimated using part of the functional independence measure (FIM). The sum of gait and stairs items [functional independence measure (locomotion), FIM-L; possible scores, 2–14] and neurological status were estimated using the Japanese Orthopaedic Association (JOA) score (possible score, 0–17). Pre-operative neurological anamnesis was reviewed, and the surgical results of elderly patients with or without co-existing neurological history were evaluated to determine the origin of locomotor disability.

Results

Peri-operative FIM-L and JOA scores were significantly lower in the elderly group than in the younger group, and the opposite was true for improved FIM score. Cerebral infarction and previous lumbar surgery were identified as neurological co-morbidities in the elderly group. However, there was no significant difference in surgical results between elderly patients with and without co-existing neurological disorders.

Conclusions

Decompression surgery can improve locomotor ability and decrease nursing care requirements among elderly patients with CSM. However, other neurological diseases can co-exist in elderly patients, making it difficult to diagnose the origin of locomotor disability. Therefore, detailed peri-operative work-up and timely decompression should be given priority to avoid progression towards fixed locomotor disability.

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Conflict of interest

None of the authors of this manuscript has received any type of support, benefits or funding from any commercial party related directly or indirectly to the subject of this article.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Hamamatsu Medical Center, 328 Tomizuka-cho Naka-ku, Hamamatsu, Shizuoka, 432-8580, Japan

    Go Yoshida

  2. Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Aichi, Japan

    Tokumi Kanemura, Yoshimoto Ishikawa & Akiyuki Matsumoto

  3. Department of Orthopedic Surgery, Nagoya University, Nagoya, Japan

    Zenya Ito, Ryoji Tauchi, Akio Muramoto & Naoki Ishiguro

  4. Department of Orthopedic Surgery, Hamamatsu Medical University, Hamamatsu, Shizuoka, Japan

    Yukihiro Matsuyama

Authors
  1. Go Yoshida
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  2. Tokumi Kanemura
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  3. Yoshimoto Ishikawa
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  4. Akiyuki Matsumoto
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  5. Zenya Ito
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  6. Ryoji Tauchi
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  8. Yukihiro Matsuyama
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  9. Naoki Ishiguro
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Corresponding author

Correspondence to Go Yoshida.

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Yoshida, G., Kanemura, T., Ishikawa, Y. et al. The effects of surgery on locomotion in elderly patients with cervical spondylotic myelopathy. Eur Spine J 22, 2545–2551 (2013). https://doi.org/10.1007/s00586-013-2961-8

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  • DOI: https://doi.org/10.1007/s00586-013-2961-8

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