title: Does age affect surgical outcomes in patients with degenerative cervical myelopathy? Results from the prospective multicenter AOSpine International study on 479 patients.
abstract: BACKGROUND
  In general, older patients with degenerative cervical myelopathy (DCM) are felt to have lower recovery potential following surgery due to increased degenerative pathology, comorbidities, reduced physiological reserves and age-related changes to the spinal cord. This study aims to determine whether age truly is an independent predictor of surgical outcome and to provide evidence to guide practice and decision-making.
  
  
  METHODS
  A total of 479 patients with DCM were prospectively enrolled in the CSM-International study at 16 centres. Our sample was divided into a younger group (<65 years) and an elderly (≥65 years) group. A mixed model analytic approach was used to evaluate differences in the modified Japanese Orthopaedic Association (mJOA), Nurick, Short Form-36 (SF-36) and Neck Disability Index (NDI) scores between groups. We first created an unadjusted model between age and surgical outcome and then developed two adjusted models that accounted for variations in (1) baseline characteristics and (2) both baseline and surgical factors.
  
  
  RESULTS
  Of the 479 patients, 360 (75.16%) were <65 years and 119 (24.84%) were ≥65 years. Elderly patients had a worse preoperative health status (p<0.0001) and were functionally more severe (p<0.0001). The majority of younger patients (64.96%) underwent anterior surgery, whereas the preferred approach in the elderly group was posterior (58.62%, p<0.0001). Elderly patients had a greater number of decompressed levels than younger patients (p<0.0001). At 24 months after surgery, younger patients achieved a higher postoperative mJOA (p<0.0001) and a lower Nurick score (p<0.0001) than elderly patients. After adjustments for patient and surgical characteristics, these differences in postoperative outcome scores decreased but remained significant.
  
  
  CONCLUSIONS
  Older age is an independent predictor of functional status in patients with DCM. However, patients over 65 with DCM still achieve functionally significant improvement after surgical decompression.
authors.affiliation: Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakashima
authors.affiliation: Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lindsay A
authors.initials: LA
authors.lastname: Tetreault
authors.affiliation: Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Narihito
authors.initials: N
authors.lastname: Nagoshi
authors.affiliation: Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Aria
authors.initials: A
authors.lastname: Nouri
authors.affiliation: Department of Health Services, University of Washington, Seattle, Washington, USA.
authors.forename: Branko
authors.initials: B
authors.lastname: Kopjar
authors.affiliation: Department Neurosurgery, University of Kansas, Kansas City, Kansas, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Arnold
authors.affiliation: Department of Neurosurgery, Radboud University Medical Center, Nijmegen, Netherlands.
authors.forename: Ronald
authors.initials: R
authors.lastname: Bartels
authors.affiliation: Faculty of Medicine, University of Sao Paulo, Ribeirão Preto, Brazil.
authors.forename: Helton
authors.initials: H
authors.lastname: Defino
authors.affiliation: Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, Delhi, India.
authors.forename: Shashank
authors.initials: S
authors.lastname: Kale
authors.affiliation: Department of Orthopedics, Third Military Medical University, Chongqing, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Zhou
authors.affiliation: Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
mesh_terms: D000367:Age Factors; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical; D004185:Disability Evaluation; D017586:Diskectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019636:Neurodegenerative Diseases / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D011788:Quality of Life; D013117:Spinal Cord Compression / Q000601:surgery*; D013123:Spinal Fusion; D016896:Treatment Outcome