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

Clinical article

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Object

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.

Methods

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.

Results

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.

Conclusions

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. email:nobut@hiroshima-u.ac.jp.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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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).

  • View in gallery

    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).

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