CERVICAL MYELOPATHY IN ELDERLY PATIENTS - CLINICAL-RESULTS AND MRI FINDINGS BEFORE AND AFTER DECOMPRESSION SURGERY

We examined 173 patients with cervical myelopathy of various casuses. Seventy-seven patients underwent anterior decompression and fusion at not more than two levels, while 96 underwent posterior decompression b y an expansive laminoplasty. Patients were followed up for between one and 4 1/2 years and the outcome was assessed both from a functional a nd a radiological point of view. The functional assessment used was ac cording to the Japanese Orthopaedic Association (JOA) score (the highe r the better), and the imaging outcome was assessed by a midline sagit tal MRI assigned to three categories either for restoration of cord mo rphology, improvement or unchanged. Patients were divided into two gro ups: those 65 years old and older (50 patients), and those younger tha n 65 years old (123 patients). The data allowed the following conclusi ons to be reached: Older patients were likely to have more levels, and higher levels affected and as a result were more likely to require a posterior operation. The recovery rate after an anterior operation was the same as that after a posterior operation. The pre- and post-opera tive JOA scores were higher in younger patients who tended to have mil der disease with fewer levels affected. Younger patients had better mo rphological restoration. The recovery was likely to be better if the p ostoperative morphology was better. The morphology postoperatively was likely to be better if there had been less compression preoperatively . If the morphology was restored the disease duration was likely to ha ve been less. The patients did better if the cord morphology was resto red to normal, and this was easier to achieve in younger patients who had fewer levels involved and had less cord distortion preoperatively.