MICROSURGERY OF THE CERVICAL-SPINE IN ELDERLY PATIENTS .1. SURGERY OFDEGENERATIVE DISEASE

The results of microsurgery for degenerative disease of the cervical s pine are reported in 84 consecutive patients being 65 years of age or older at the time of surgery. Patients were suffering from either soft or hard disc disease or from advanced forms of cervical myelopathy. I n 60 patients microsurgical resection of the involved cervical disc an d posterior osteophytes was performed followed by anterior fusion. Spo ndylectomy, microsurgical decompression and osteosynthesis was perform ed in 24 patients with multi-level cervical stenosis. A multitude of a ccompanying systemic diseases was present in almost all patients. Eval uation of the peri-operative risk profile of the patients was performe d using the American Society of Anesthesiology (ASA) Grading of Physic al Status Score. In 82 patients a complete follow-up was available. Tw o patients died within seven days after surgery from heart attack and pulmonary embolism. Three patients died during the observation period from causes unrelated to their cervical disease or to surgery. Overall surgical results were as follows: 66 patients (79%) were improved by surgery. 14 patients (17%) were unchanged, two patients (2%) became wo rse, and two patients (2%) died. Postoperative recovery was significan tly correlated to the pre-operative neurological status. Neither age, nor the pre-operative ASA score had a significant influence on the pos toperative outcome. The incidence of peri-operative systemic complicat ions was significantly correlated to the pre-operative physical status of the patients according to the ASA score. No significant correlatio n towards an increase of peri-operative complications with higher grad es of pre-operative neurological deficits or with increasing age of th e patients could be found. It is concluded, that surgery of degenerati ve disease of the cervical spine, even in advanced cases, and with agg ressive forms of surgical treatment, can be performed in a safe and ef fective manner in elderly patients, resulting in a significant relief of pre-operative clinical symptoms and signs in the majority of patien ts.