title: The effects of surgery on locomotion in elderly patients with cervical spondylotic myelopathy.
abstract: OBJECTIVE
  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.
authors: Department of Orthopedic Surgery, Hamamatsu Medical Center, 328 Tomizuka-cho Naka-ku, Hamamatsu, Shizuoka, 432-8580, Japan, goy@K6.dion.ne.jp.
authors: Go
authors: G
authors: Yoshida
authors: Tokumi
authors: T
authors: Kanemura
authors: Yoshimoto
authors: Y
authors: Ishikawa
authors: Akiyuki
authors: A
authors: Matsumoto
authors: Zenya
authors: Z
authors: Ito
authors: Ryoji
authors: R
authors: Tauchi
authors: Akio
authors: A
authors: Muramoto
authors: Yukihiro
authors: Y
authors: Matsuyama
authors: Naoki
authors: N
authors: Ishiguro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D065406:Laminoplasty; D008124:Locomotion; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013118:Spinal Cord Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D055009:Spondylosis / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome
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