Posterior Cervical Decompression and Fusion by Age

Introduction: Degenerative cervical myelopathy is the most common etiology of spinal cord disease amongst elderly patients and is often treated with posterior cervical decompression and fusion (PCDF). The impact of age on surgical outcomes remains controversial. Our goal is to compare preoperative and postoperative patient-reported outcome measures (PROMs) in the elderly population, stratified by decade.

Methods: Adult patients who underwent a PCDF between 2017-2022 were identified and their preoperative and postoperative (3 months, 6 months, and 1 year) PROMs were collected via Structured Query Language (SQL) search. PROMs include neck disability index (NDI), visual analog score (VAS) neck and arm, modified Japanese orthopedic association (MJOA), and Short-Form 12 composed of the mental (MCS) and physical (PCS) component score. Patient demographics and surgical characteristics were collected through manual chart review and an SQL search. Patients were subsequently divided into decades based on age (50-59, 60-69, 70-79 years).

Results: The present study identified 65 (33.5%) patients aged 50-59 years, 87 (44.8%) aged 60-69, and 42 (21.6%) aged 70-79. Both CCI (2.40 ± 0.83 (50-59) vs. 3.62 ± 1.06 (60-69) vs. 30.5 ± 6.01 (70-79); p< 0.001) and the average levels fused (3.37 ± 1.81 (50-59) vs. 4.25 ± 1.91 vs. 4.64 ± 2.05 (70-79); p=0.005) increased with each increase in decade. Preoperatively, those in the 70-79 age group had better performance on NDI (20.4 ± 11.1 (50-59) vs. 17.1 ± 9.91 vs. 13.7 ± 8.06 (70-79); p=0.022) and VAS neck (5.46 ± 3.19 (50-59) vs. 4.74 ± 2.92 vs. 3.77 ± 2.60; p=0.028) and worse performance on MCS (45.1 ± 11.0 (50-59) vs. 47.7 ± 11.7 vs. 51.1 ± 11.3 (70-79); p=0.046) compared to those in 60-69 and 50-59 groups. No significant differences were seen in preoperative and postoperative MJOA, VAS arm, and PCS scores, or in the changes from preoperative to postoperative scores for any PROMs at any time point (3 months, 6 months, 1 year).

Conclusion : The current study demonstrates that patients across differing age decades (50-59 vs. 60-69 vs. 70-79 years) achieve similar magnitude of improvement in PROMs following PCDF. This suggests that older patients can benefit similarly from PCDF compared to younger patients.