title: Results of surgical treatment of cervical spondylotic myelopathy in patients aged 75 years or more: a comparative study of operative methods.
abstract: BACKGROUND
  The number of surgical procedures in elderly patients has been increasing as the population has grown older; recently, spine surgeons have been more likely to encounter elderly patients with cervical myelopathy in need of surgical treatment. There are many reports about surgical treatment of elderly patients with cervical spondylotic myelopathy (CSM); however, there are no studies about the proper selection of surgical methods and comparison of their results in CSM patients aged ≥ 75 years. The objective of this study was to review the results of operative methods in CSM patients aged ≥ 75 years.
  
  
  METHODS
  Forty-three consecutive cases with an average age of 79 years that underwent surgical treatment were included in this study. The neurological severity was assessed using the Japanese Orthopaedic Association score for cervical myelopathy (JOA). The JOA scores were evaluated before surgery and at final follow-up. There were 21 laminoplasty procedures (from C3 to C7), 13 selective laminoplasty procedures (one above and one below the affected intervertebral level), and nine anterior decompression and fusion procedures. A selective laminoplasty was performed in cases with general complications and was diagnosed as one intervertebral level both clinically and electrophysiologically. Surgical results were compared among the three treatment groups.
  
  
  RESULTS
  The average preoperative JOA score was 7.7 points and the average JOA recovery rate was 45 %. There were three cases of C5 palsy and one wound infection. Operative time and intraoperative bleeding in the selective laminoplasty group were significantly smaller than those in the other groups. There was no significant difference in the JOA recovery rates among the groups.
  
  
  CONCLUSIONS
  Selective laminoplasty is less invasive and the surgical results in our study were almost good. It also has good short-term results. However, the indication for surgery has to be selected carefully in elderly CSM patients.
authors.affiliation: Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, 755-8505, Japan, tkanchik@yamaguchi-u.ac.jp.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Kanchiku
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Imajo
authors.forename: Hidenori
authors.initials: H
authors.lastname: Suzuki
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Norihiro
authors.initials: N
authors.lastname: Nishida
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Taguchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D005071:Evoked Potentials; D005260:Female; D006801:Humans; D007796:Laminectomy; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D055009:Spondylosis / Q000145:classification / Q000601:surgery*; D016896:Treatment Outcome