Differences in postoperative quality of life in young, early elderly, and late elderly patients undergoing surgical treatment for degenerative cervical myelopathy

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  • 1 Department of Neurological Surgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah;
  • | 2 Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;
  • | 3 Department of Neurosurgery, University of California, San Francisco, California;
  • | 4 Norton Leatherman Spine Center, Louisville, Kentucky;
  • | 5 Department of Neurosurgery, University of Tennessee, Memphis, Tennessee;
  • | 6 Department of Neurosurgery, Indiana University; Goodman Campbell Brain and Spine, Indianapolis, Indiana;
  • | 7 Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia;
  • | 8 Department of Neurosurgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas HealthCare System, Charlotte, North Carolina;
  • | 9 Atlantic Neurosurgical Specialists, Morristown, New Jersey;
  • | 10 Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan;
  • | 11 Department of Neurosurgery, University of Miami, Miami, Florida;
  • | 12 Department of Neurosurgery, Weill Cornell Medical College, New York, New York;
  • | 13 Geisinger Health, Danville, Pennsylvania; and
  • | 14 Department of Neurosurgery, Duke University, Durham, North Carolina
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OBJECTIVE

Cervical spondylotic myelopathy (CSM) is a common progressive spine disorder affecting predominantly middle-aged and elderly populations. With increasing life expectancy, the incidence of CSM is expected to rise further. The outcomes of elderly patients undergoing CSM surgery and especially their quality of life (QOL) postoperatively remain undetermined. This study retrospectively reviewed patients to identify baseline differences and validated postoperative patient-reported outcome (PRO) measures in elderly patients undergoing CSM surgery.

METHODS

The multi-institutional, neurosurgery-specific NeuroPoint Quality Outcomes Database was queried to identify CSM patients treated surgically at the 14 highest-volume sites from January 2016 to December 2018. Patients were divided into three groups: young (< 65 years), early elderly (65–74 years), and late elderly (≥ 75 years). Demographic and PRO measures (Neck Disability Index [NDI] score, modified Japanese Orthopaedic Association [mJOA] score, EQ-5D score, EQ-5D visual analog scale [VAS] score, arm pain VAS, and neck pain VAS) were compared among the groups at baseline and 3 and 12 months postoperatively.

RESULTS

A total of 1151 patients were identified: 691 patients (60%) in the young, 331 patients (28.7%) in the early elderly, and 129 patients (11.2%) in the late elderly groups. At baseline, younger patients presented with worse NDI scores (p < 0.001) and lower EQ-5D VAS (p = 0.004) and EQ-5D (p < 0.001) scores compared with early and late elderly patients. No differences among age groups were found in the mJOA score. An improvement of all QOL scores was noted in all age groups. On unadjusted analysis at 3 months, younger patients had greater improvement in arm pain VAS, NDI, and EQ-5D VAS compared with early and late elderly patients. At 12 months, the same changes were seen, but on adjusted analysis, there were no differences in PROs between the age groups.

CONCLUSIONS

The authors’ results indicate that elderly patients undergoing CSM surgery achieved QOL outcomes that were equivalent to those of younger patients at the 12-month follow-up.

ABBREVIATIONS

ASA = American Society of Anesthesiologists; CSM = cervical spondylotic myelopathy; MCID = minimal clinically important difference; mJOA = modified Japanese Orthopaedic Association; NDI = Neck Disability Index; PRO = patient-reported outcome; QOD = Quality Outcomes Database; QOL = quality of life; VAS = visual analog scale.

Illustration from Dibble et al. (pp 384–394). © Washington University Department of Neurosurgery, published with permission.

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