Clinical results of cervical myelopathy in patients older than 80 years of age: evaluation of spinal function with motor evoked potentials

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In this prospective analysis the authors describe the clinical results of surgical treatment in patients > 80 years of age in whom spinal function was evaluated with motor evoked potential (MEPs) monitoring.


The authors included 57 patients > 80 years of age who were suspected of having cervical myelopathy. The mean age of the patients was 83.0 years (range 80–90 years). The central motor conduction time (CMCT) was calculated from the latencies of the MEPs following transcranial magnetic stimulation and from M and F waves following peripheral nerve stimulation.


Preoperative electrophysiological evaluation demonstrated significant elongation of CMCT or abnormalities in MEP waveforms in 37 patients (65%), and 35 patients of these underwent laminoplasty. In 30 patients cervical spondylotic myelopathy was diagnosed and 5 patients ossification of the posterior longitudinal ligament was diagnosed. The preoperative mean Japanese Orthopaedic Association Scale score was 8.6 (range 3–12.5) and the mean postoperative score was 12.6 (range 6–14.5) with an average recovery rate of 45% (range −21 to 100%). There were no major complications in any of the patients during the operative period and there were no cases of death resulting from operative intervention.


Sufficient clinical results are expected even in patients with myelopathy who are older than 80 years of age, provided the patients are correctly selected by electrophysiological evaluation with MEPs and CMCT.

Abbreviations used in this paper: ASA = American Society of Anesthesiologists; CMCT = central motor conduction time; JOA = Japanese Orthopaedic Association; MEP = motor evoked potential; RR = recovery rate; TMS = transcranial magnetic stimulation.

Article Information

Address correspondence to: Nobuhiro Tanaka, M.D., Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8551, Japan.

© AANS, except where prohibited by US copyright law.



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    Bar graphs showing the mean preoperative CMCT from abductor digiti minimi muscles for the upper extremities (left) and the mean preoperative CMCT from abductor hallucis muscles for the lower extremities in elderly patients with cervical myelopathy. ms = msec. *p < 0.05.

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    Magnetic resonance images obtained in an 86-year-old woman. The preoperative T1-weighted (left) and T2-weighted (right) sagittal images demonstrate spinal canal stenosis at C3–4, 4–5, and C5–6.

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    Waveform. The MEPs following TMS (upper) and M- and F-waves following ulnar nerve stimulation (lower) were recorded from the right abductor digiti minimi muscle. The latency of the MEPs was 27.5 msec and those of the M- and F-waves were 2.5 and 24.3 msec, respectively. The preoperative CMCT for the right upper extremity was 14.9 msec (normal control 8.0 ± 1.0 msec).

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    Waveform. The MEP following TMS (upper) and M- and F-waves following tibial nerve stimulation (lower) were recorded from the right abductor hallucis muscle. The study of the MEPs showed abnormal polyphasic waveforms. The latency of the MEPs was 43.5 msec and those of the M- and F-waves were 4.8 and 42.6 msec, respectively. The preoperative CMCT for the right lower extremity was 20.3 msec (normal control 14.4 ± 1.0 msec).


  • 1

    Barker ATJalinous RFreeston IL: Non-invasive magnetic stimulation of human motor cortex. Lancet 1:110611071985

  • 2

    Chen RCros DCurra ADi Lazzaro VLefaucheur JPMagistris MR: The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol 119:5045322008

  • 3

    Di Lazzaro VRestuccia DColosimo CTonali P: The contribution of magnetic stimulation of the motor cortex to the diagnosis of cervical spondylotic myelopathy. Correlation of central motor conduction to distal and proximal upper limb muscles with clinical and MRI findings. Electroencephalogr Clin Neurophysiol 85:3113201992

  • 4

    Edwards CC IIHeller JGMurakami H: Corpectomy versus laminoplasty for multilevel cervical myelopathy: an independent matched-cohort analysis. Spine 27:116811752002

  • 5

    Hasegawa KHomma TChiba YHirano TWatanabe KYamazaki A: Effects of surgical treatment for cervical spondylotic myelopathy in patients > or = 70 years of age: a retrospective comparative study. J Spinal Disord Tech 15:4584602002

  • 6

    Hirabayashi KMiyakawa JSatomi KMaruyama TWakano K: Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine 6:3543641981

  • 7

    Japanese Ministry of Health Labour and Welfare: Vital statistics: life expectancies at specified ages ( [Accessed 8 June 2009]

  • 8

    Kaneko KTaguchi TMorita HYonemura HFujimoto HKawai S: Mechanism of prolonged central motor conduction time in compressive cervical myelopathy. Clin Neurophysiol 112:103510402001

  • 9

    Matsuda YShibata TOki SKawatani YMashima NOishi H: Outcomes of surgical treatment for cervical myelopathy in patients more than 75 years of age. Spine 24:5295341999

  • 10

    Nagata KOhashi TAbe JMorita MInoue A: Cervical myelopathy in elderly patients: clinical results and MRI findings before and after decompression surgery. Spinal Cord 34:2202261996

  • 11

    Nakanishi KTanaka NFujiwara YKamei NOchi M: Corticospinal tract conduction block results in the prolongation of central motor conduction time in compressive cervical myelopathy. Clin Neurophysiol 117:6236272006

  • 12

    Nakanishi KTanaka NKamei NHamasaki TNishida KTouten Y: Significant correlation between corticospinal tract conduction block and prolongation of central motor conduction time in compressive cervical myelopathy. J Neurol Sci 256:71742007

  • 13

    Shiraishi TFukuda KYato YNakamura MIkegami T: Results of skip laminectomy-minimum 2-year follow-up study compared with open-door laminoplasty. Spine 28:266726722003

  • 14

    Smith EBHanigan WC: Surgical results and complications in elderly patients with benign lesions of the spinal canal. J Am Geriatr Soc 40:8678701992

  • 15

    Takahashi JHirabayashi HHashidate HOgihara NYamazaki IKamimura M: Assessment of cervical myelopathy using transcranial magnetic stimulation and prediction of prognosis after laminoplasty. Spine 33:E15E202008

  • 16

    Tanaka NFujimoto YYasunaga YOchi M: Functional diagnosis using multimodal spinal cord evoked potentials in cervical myelopathy. J Orthop Sci 10:372005

  • 17

    Tavy DLWagner GLKeunen RWWattendorff ARHekster REFranssen H: Transcranial magnetic stimulation in patients with cervical spondylotic myelopathy: clinical and radiological correlations. Muscle Nerve 17:2352411994

  • 18

    Taylor JJohnston RACaird FI: Surgical treatment of cervical spondylotic myelopathy in elderly patients. Age Ageing 20:4074121991

  • 19

    Teresi LMLufkin RBReicher MAMoffit BJVinuela FVWilson GM: Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging. Radiology 164:83881987

  • 20

    Yonenobu KOkada KFuji TFujiwara KYamashita KOno K: Causes of neurologic deterioration following surgical treatment of cervical myelopathy. Spine 11:8188231986




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