Outcome Analysis of Cervical Myelopathy in Patients

Kyung Won Song; In Heon Park; Sung Il Shin; Jin Young Lee; Ho Dong Moon

doi:10.4184/jkss.2001.8.1.68

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Song, Park, Shin, Lee, and Moon: Outcome Analysis of Cervical Myelopathy in Patients

Original Article

Journal of Korean Spine Surg 2001;8(1):68-73.

Published online: 12 February 2001

DOI: https://doi.org/10.4184/jkss.2001.8.1.68

Outcome Analysis of Cervical Myelopathy in Patients

Kyung Won Song, M.D., In Heon Park, M.D., Sung Il Shin, M.D., Jin Young Lee, M.D., Ho Dong Moon, M.D.

Department of Orthopaedic Surgery, Kang-Dong Sacred Heart Hospital College of Medicine, Hallym University, Seoul, Korea

Address reprint requests to Kyung Won Song, M.D. Department of Orthopaedic Surgery, College of Medicine, Hallym University #445 Gil-dong, Kangdong-gu, Seoul, 134-701, Korea Tel : 82-2-2224-2230, Fax : 82-2-489-4391, E-mail : skw@www.hallym.or.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A retrospective study.

Objectives

To evaluate the surgical outcomes and image by mid- sagittal MRI in patients with cervical myelopathy who were more than 70 years of age.

Summary of literature Review

Surgical outcomes of cervical myelopathy in the elderly patients were worse than in the younger patients, but decompression surgery is helpful for improving neurologic function in the elderly.

Materials and Methods

Nine patients more than 70 years of age who underwent surgery were reviewed. Neurologic deficits after surgery were assessed using a scoring system proposed by Japanese Orthopaedic A ssociation(JOA) and clinical results and morphological changes on MRI were compared with those of patients less than 70 years old age.

Results

The preoperative mean JOA score was 8.5 and the postoperative mean JOA score 12.8 and the maximum recovery rate was 51.1%, but these were significantly inferior to scores in those less than 70 years of age. A t the time of final follow up, the mean JOA score had decreased 11.3 and the recovery rate was 32.6%. All patients except one were improved their daily living function. On the postoperative midline T1 sagittal MRI, morphological improvement was seen in 44% in patients more than 70 years of age, while 69% of patients were improved in the control group.

Conclusions

Surgical decompression appears to be necessary as soon as possible after the onset of progressive myelopathy in the elderly patients for improving neurologic function and ability to engage in daily living.

Keywords: Cervical spine, Myelopathy, A ged, Decompression surgery

REFERENCES

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Fig. 1.

Classification of compressed deformities in the cervical cord on the sagittal MRI.

Fig. 2.

Change in the JOA score.

Fig. 3.

72-year-old woman. A. preoperative lateral radiograph. B. postoperative lateral radiograph.

Fig. 4.

72-year-old woman. A, B. preoperative sagittal MRI. C, D. postoperative sagittal MRI

Fig. 5.

71-year-old man. A. preoperative lateral radiograph. B. postoperative lateral radiograph.

Fig. 6.

71-year-old man. A. preoperative sagittal T2-weighted MRI showed high signal area. C. postoperative sagittal T2-weighted MRI showed no signal change.

Fig. 7.

73-year-old man. A. preoperative sagittal MRI. B. post-operative sagittal MRI.

Table 1.

JOA scoring system & Recovery rate in Cervical Myelopathy

I Motor dysfunction(upper extremities)

0 Unable to feed oneself

1 Unable to handle chopsticks, able to eat with a spoon

2 Handle chopsticks with much difficulty

3 Handle chopsticks with slight difficulty

4 None

II Motor dysfunction(lower extremities)

0 Unable to walk

1 Walk with walking aid

2 Able to go up and/or down stairs with handrail for support

3 Lack of stability and smooth gait

4 None

III Sensory deficit

A Upper extremities

0 Severe sensory loss or pain

1 Mild sensory loss

2 None

B Lower extremities same as A

C Trunk same as A

IV Sphinter dysfunction

0 Unable to void

1 Marked difficulty in micturition(retention, stran-gury)

2 Difficulty in micturition(pollakisuria, hesitation)

3 None

Recovery rate = postop.score - preop.score / 17 - preop.score x 100 %

Table 2.

The clinical results in aged and control group

	control group	70 years older patients	P value
Disease duration (month)	24(6 - 52)	45(12 - 132)	-
JOA score
preoperation	10.3	8.5	NS
postoperation	14.5	12.8	<0.01
final F/U	13.2	11.3	<0.01
Recovery rate(%)
postoperation	62.6	51.1	<0.01
final F/U	52.3	32.6	<0.01
Four degrees evaluation
excellent	3	0
good	7	6	-
fair	3	3
unchanged	0	0

NS = not significant

Table 3.

Pre- & Post-operative MRI findings

	control group	70 years older patients
Preoperative MRI
Class 0	0	0
Class 1	1(8%)	0
Class 2	5(38%)	2(22%)
Class 3	7(54%)	7(78%)
Postoperative MRI
Class 0	2(16%)	0
Class 1	5(38%)	2(22%)
Class 2	4(30%)	3(33%)
Class 3	2(16%)	4(45%)

Table 4.

The level of cord compression

Level	control	70 years older patients
C2/3	0	2(22%)
C3/4	3(23%)	7(78%)
C4/5	10(77%)	9(100%)
C5/6	9(69%)	6(67%)
C6/7	2(15%)	4(44%)

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