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Desouza C, Shetty V. Beyond one step: unveiling optimal approach for bilateral knee arthroplasty - a comprehensive meta-analysis. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05454-8. [PMID: 39039313 DOI: 10.1007/s00402-024-05454-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 07/02/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is an efficient and common procedure used to treat advanced osteoarthritis of the knee. Geriatric patients make up the majority of TKA patients. For the surgical management of bilateral knee arthritis, there is still debate regarding whether to do a simultaneous or staged TKA. We through this study have gathered data and aimed to assess the safety of simultaneous bilateral TKA in patients. MATERIALS AND METHODS We conducted a study according to the PRISMA guidelines by searching through various databases for the following search terms: total knee arthroplasty (TKA), complications following TKA, bilateral TKA, and bilateral vs. unilateral TKA. The search included case series and clinical trials and excluded review articles, yielding 24 articles from the original search. We extracted data upon the outcomes in patients undergoing simultaneous bilateral TKA. We performed additional bias assessments to validate our search algorithm and results. RESULTS One hundred and three published articles were identified, and twenty-four that included a total of 2, 18,385 patients were included in the meta-analysis. 93,074 patients underwent simultaneous bilateral TKA and 125,311 patients underwent staged bilateral TKA. Simultaneous bilateral TKA was associated with significantly increased mortality rate (P < 0.00001, Odd's ratio [OR] 1.86, 95% Confidence interval [CI] 1.53-2.26), increased incidence of pulmonary embolism (P < 0.00001, OR 1.58, 95% CI 1.30-1.91), deep venous thrombosis (P < 0.00001, OR 1.31, 95% CI 1.17-1.46), and neurological complications (P < 0.002, OR 1.44, 95% CI 1.14-1.82). There were no significant differences in cardiac complications between both the procedures (P = 0.60, OR 0.93, 95% CI 0.70-1.23). CONCLUSION Staged bilateral TKA is associated with less complication rates as compared to simultaneous bilateral TKA. Hence, patients should be counselled and selected based on the risks respective to each strategy.
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Affiliation(s)
- Clevio Desouza
- SAANVI Orthopaedics, Sorrento Building, High St, Hiranandani Gardens, Powai, Mumbai, 400076, Maharashtra, India.
- Centre for Bone and Joints, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India.
| | - Vijay Shetty
- SAANVI Orthopaedics, Sorrento Building, High St, Hiranandani Gardens, Powai, Mumbai, 400076, Maharashtra, India
- Dr L H Hiranandani Hospital, Powai, Mumbai, India
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Elsamadicy AA, Koo AB, Reeves BC, Freedman IG, David WB, Ehresman J, Pennington Z, Laurans M, Kolb L, Sciubba DM. Octogenarians Are Independently Associated With Extended LOS and Non-Routine Discharge After Elective ACDF for CSM. Global Spine J 2022; 12:1792-1803. [PMID: 33511889 PMCID: PMC9609534 DOI: 10.1177/2192568221989293] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of this study was to determine the impact age has on LOS and discharge disposition following elective ACDF for cervical spondylotic myelopathy (CSM). METHODS A retrospective cohort study was performed using the National Inpatient Sample (NIS) database from 2016 and 2017. All adult patients >50 years old undergoing ACDF for CSM were identified using the ICD-10-CM diagnosis and procedural coding system. Patients were then stratified by age: 50 to 64 years-old, 65 to 79 years-old, and greater than or equal to 80 years-old. Weighted patient demographics, comorbidities, perioperative complications, LOS, discharge disposition, and total cost of admission were assessed. RESULTS A total of 14 865 patients were identified. Compared to the 50-64 and 65-79 year-old cohorts, the 80+ years cohort had a significantly higher rate of postoperative complication (50-64 yo:10.2% vs. 65-79 yo:12.6% vs. 80+ yo:18.9%, P = 0.048). The 80+ years cohort experienced significantly longer hospital stays (50-64 yo: 2.0 ± 2.4 days vs. 65-79 yo: 2.2 ± 2.8 days vs. 80+ yo: 2.3 ± 2.1 days, P = 0.028), higher proportion of patients with extended LOS (50-64 yo:18.3% vs. 65-79 yo:21.9% vs. 80+ yo:28.4%, P = 0.009), and increased rates of non-routine discharges (50-64 yo:15.1% vs. 65-79 yo:23.0% vs. 80+ yo:35.8%, P < 0.001). On multivariate analysis, age 80+ years was found to be a significant independent predictor of extended LOS [OR:1.97, 95% CI:(1.10,3.55), P = 0.023] and non-routine discharge [OR:2.46, 95% CI:(1.44,4.21), P = 0.001]. CONCLUSIONS Our study demonstrates that octogenarian age status is a significant independent risk factor for extended LOS and non-routine discharge after elective ACDF for CSM.
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Affiliation(s)
- Aladine A. Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- Aladine A. Elsamadicy, Department of
Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven,
CT 06520, USA.
| | - Andrew B. Koo
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Benjamin C. Reeves
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Isaac G. Freedman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Wyatt B. David
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Jeff Ehresman
- Department of Neurosurgery, John Hopkins School of Medicine, Baltimore, MD, USA
| | - Zach Pennington
- Department of Neurosurgery, John Hopkins School of Medicine, Baltimore, MD, USA
| | - Maxwell Laurans
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Luis Kolb
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Daniel M. Sciubba
- Department of Neurosurgery, John Hopkins School of Medicine, Baltimore, MD, USA
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TÜRKOĞLU ME, GÜLMEZ A, ELBİR Ç, ŞAHİN ÖS, HANALİOĞLU Ş, DİNÇ S, TÖNGE Ç, KALAN M. Surgical outcome of laminoplasty for cervical spondylotic myelopathy: a single-institution experience. Turk J Med Sci 2021; 51:2887-2896. [PMID: 33890448 PMCID: PMC10734866 DOI: 10.3906/sag-2102-308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 12/13/2021] [Accepted: 04/21/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim Cervical spondylotic myelopathy (CSM) develops as a result of compression of the spinal cord in the cervical region. Early diagnosis and surgical treatment can limit the progression of symptoms. Various surgical approaches and strategies have been described in the literature. This study aims to evaluate the clinical and radiological results of open-door laminoplasty for the treatment of CSM. Materials and methods In this study, we retrospectively analyzed the patients who underwent expansive open-door laminoplasty secured with titanium miniplates. Thirty-four patients with CSM who were followed up postoperatively for more than 12 months were included in the study. The modified Japanese Orthopaedic Association (mJOA) score was used to assess the degree of myelopathy. We evaluated cervical sagittal alignment with C2–C7 Cobb angle, the ambulatory status with the Nurick grade, and measured postoperative neck pain with the visual analogue scale (VAS). Results Themeanm JOA score was 11 (range 6–15) preoperatively, and 13.5 (range 9–16) postoperatively with an average 55% recovery rate (range 0–75) (p < 0.001). Themean–Nurick grade was 2 (range 1–3) preoperatively and 1 (range 0–3) postoperatively (p < 0.001). The median cervical lordotic angle increased from 7.5 ° preoperatively to 12.5 ° postoperatively (p = 0.044). K-line (+) patients› mean mJOA scores significantly increased from 10.8 ± 1.7 to 13.3 ± 1.7 postoperatively (p < 0.001). The mean preoperative VAS reduced from 2.66 ± 1.4 to 1.59 ± 1.4 postoperatively (p < 0.001). Conclusion Open-door laminoplasty technique is an effective surgical procedure that can be used safely to treat cervical spondylotic myelopathy. Our findings suggest that it can limit the progression of symptoms and alter the poor prognosis in CSM.
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Affiliation(s)
- M. Erhan TÜRKOĞLU
- Department of Neurosurgery, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Faculty of Gülhane Medicine, University of Health Sciences, Ankara,
Turkey
| | - Ahmet GÜLMEZ
- Neurosurgery Clinic, Yozgat City Hospital, Ministry of Health, Yozgat,
Turkey
| | - Çağirı ELBİR
- Department of Neurosurgery, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Faculty of Gülhane Medicine, University of Health Sciences, Ankara,
Turkey
| | - Ömer Selçuk ŞAHİN
- Department of Neurosurgery, Mengücek Gazi Education and Research Hospital, Erzincan Binali Yıldırım University, Erzincan,
Turkey
| | - Şahin HANALİOĞLU
- Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - Samet DİNÇ
- Department of Neurosurgery, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Faculty of Gülhane Medicine, University of Health Sciences, Ankara,
Turkey
| | - Çağhan TÖNGE
- Department of Neurosurgery, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Faculty of Gülhane Medicine, University of Health Sciences, Ankara,
Turkey
| | - Mehmet KALAN
- Department of Neurosurgery, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Faculty of Gülhane Medicine, University of Health Sciences, Ankara,
Turkey
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First neurological symptoms in degenerative cervical myelopathy: does it predict the outcome? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:327-333. [PMID: 34822020 DOI: 10.1007/s00586-021-07060-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/27/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Degenerative cervical myelopathy (DCM) is the most common non-traumatic cause of spinal cord dysfunction. Prediction of the neurological outcome after surgery is important. The aim of this study was to analyze the relationship between first symptoms of DCM and the neurological outcome after surgery. METHODS A retrospective analysis over a period of 10 years was performed. First symptoms such as cervicobrachial neuralgia, sensory and motor deficits and gait disturbances were evaluated regarding the postoperative neurological outcome. The modified Japanese Orthopedic Association Score (mJOA Score) was used to evaluate neurological outcome. RESULTS In total, 411 patients (263 males, 64%) with a median age of 62.6 ± 12.1 years were included. Cervicobrachial neuralgia was described in 40.2%, gait disturbance in 31.6%, sensory deficits in 19% and motor deficits in 9.2% as first symptom. Patients with cervicobrachial neuralgia were significantly younger (median age of 58 years, p = 0.0005) than patients with gait disturbances (median age of 68 years, p = 0.0005). Patients with gait disturbances and motor deficits as first symptom showed significantly lower mJOA Scores than other patients (p = 0.0005). Additionally, motor deficits and gait disturbance were negative predictors for postoperative outcome according to the mJOA Score. CONCLUSION Motor deficits and gait disturbances as the first symptom of DCM are negative predictors for postoperative neurological outcome. Nevertheless, patients with motor deficits and gait disturbance significantly profit from the surgical treatment despite poor preoperative mJOA Score.
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Gembruch O, Jabbarli R, Rashidi A, Chihi M, El Hindy N, Wetter A, Hütter BO, Sure U, Dammann P, Özkan N. Degenerative Cervical Myelopathy in Higher-Aged Patients: How Do They Benefit from Surgery? J Clin Med 2019; 9:jcm9010062. [PMID: 31888031 PMCID: PMC7019793 DOI: 10.3390/jcm9010062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/17/2019] [Accepted: 12/24/2019] [Indexed: 01/16/2023] Open
Abstract
Background: Degenerative cervical myelopathy (DCM) is the most common reason for spinal cord disease in elderly patients. This study analyzes the preoperative status and postoperative outcome of higher-aged patients in comparison to young and elderly patients in order to determine the benefit to those patients from DCM surgery. Methods: A retrospective analysis of the clinical data, radiological findings, and operative reports of 411 patients treated surgically between 2007 and 2016 suffering from DCM was performed. The preoperative and postoperative neurological functions were evaluated using the modified Japanese Orthopedic Association Score (mJOA Score), the postoperative mJOA Score improvement, the neurological recovery rate (NRR) of the mJOA Score, and the minimum clinically important difference (MCID). The Charlson Comorbidity Index (CCI) was used to evaluate the impact of comorbidities on the preoperative and postoperative mJOA Score. The comparisons were performed between the following age groups: G1: ≤50 years, G2: 51–70 years, and G3: >70 years. Results: The preoperative and postoperative mJOA Score was significantly lower in G3 than in G2 and G1 (p < 0.0001). However, the mean mJOA Score’s improvement did not differ significantly (p = 0.81) between those groups six months after surgery (G1: 1.99 ± 1.04, G2: 2.01 ± 1.04, G: 2.00 ± 0.91). Furthermore, the MCID showed a significant improvement in every age-group. The CCI was evaluated for each age-group, showing a statistically significant group effect (p < 0.0001). Analysis of variance revealed a significant group effect on the delay (weeks) between symptom onset and surgery (p = 0.003). The duration of the stay at the hospital did differ significantly between the age groups (p < 0.0001). Conclusion: Preoperative and postoperative mJOA Scores, but not the extent of postoperative improvement, are affected by the patients’ age. Therefore, patients should be considered for DCM surgery regardless of their age.
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Affiliation(s)
- Oliver Gembruch
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
- Correspondence: ; Tel.: +49-(0)201-723-1201; Fax: +49-(0)201-723-5909
| | - Ramazan Jabbarli
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Ali Rashidi
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Mehdi Chihi
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Nicolai El Hindy
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
- Spine-Center Werne, Katholisches Klinikum Lünen/Werne GmbH, St. Christophorus-Krankenhaus, Am See 1, 59368 Werne, Germany
| | - Axel Wetter
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Bernd-Otto Hütter
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Neriman Özkan
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
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Lin IS, Lai DM, Ding JJ, Chien A, Cheng CH, Wang SF, Wang JL, Kuo CL, Hsu WL. Reweighting of the sensory inputs for postural control in patients with cervical spondylotic myelopathy after surgery. J Neuroeng Rehabil 2019; 16:96. [PMID: 31345240 PMCID: PMC6659243 DOI: 10.1186/s12984-019-0564-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 07/04/2019] [Indexed: 11/22/2022] Open
Abstract
Background Cervical spondylotic myelopathy (CSM) is a degenerative cervical disease in which the spinal cord is compressed. Patients with CSM experience balance disturbance because of impaired proprioception. The weighting of the sensory inputs for postural control in patients with CSM is unclear. Therefore, this study investigated the weighting of sensory systems in patients with CSM. Method Twenty-four individuals with CSM (CSM group) and 24 age-matched healthy adults (healthy control group) were analyzed in this observational study. The functional outcomes (modified Japanese Orthopaedic Association Scale [mJOA], Japanese Orthopaedic Association Cervical Myelopathy Questionnaire [JOACMEQ], Nurick scale) and static balance (eyes-open and eyes-closed conditions) were assessed for individuals with CSM before surgery, 3 and 6 months after surgery. Time-domain and time–frequency-domain variables of the center of pressure (COP) were analyzed to examine the weighting of the sensory systems. Results In the CSM group, lower extremity function of mJOA and Nurick scale significantly improved 3 and 6 months after surgery. Before surgery, the COP mean velocity and total energy were significantly higher in the CSM group than in the control group for both vision conditions. Compared with the control group, the CSM group exhibited lower energy content in the moderate-frequency band (i.e., proprioception) and higher energy content in the low-frequency band (i.e., cerebellar, vestibular, and visual systems) under the eyes-open condition. The COP mean velocity of the CSM group significantly decreased 3 months after surgery. The energy content in the low-frequency band (i.e., visual and vestibular systems) of the CSM group was closed to that of the control group 6 months after surgery under the eyes-open condition. Conclusion Before surgery, the patients with CSM may have had compensatory sensory weighting for postural control, with decreased weighting on proprioception and increased weighting on the other three sensory inputs. After surgery, the postural control of the patients with CSM improved, with decreased compensation for the proprioceptive system from the visual and vestibular inputs. However, the improvement remained insufficient because the patients with CSM still had lower weighting on proprioception than the healthy adults did. Therefore, patients with CSM may require balance training and posture education after surgery. Trial registration Trial Registration number: NCT03396055 Name of the registry: ClinicalTrials.gov Date of registration: January 10, 2018 - Retrospectively registered Date of enrolment of the first participant to the trial: October 19, 2015
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Affiliation(s)
- Iu-Shiuan Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Floor 3, No. 17, Xuzhou Rd., Zhongzheng District, Taipei, Taiwan.,Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Dar-Ming Lai
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Jian-Jiun Ding
- Graduate Institute of Communication Engineering, College of Electrical Engineering and Computer Science, National Taiwan University, Taipei, Taiwan
| | - Andy Chien
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
| | - Chih-Hsiu Cheng
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shwu-Fen Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Floor 3, No. 17, Xuzhou Rd., Zhongzheng District, Taipei, Taiwan.,Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Jaw-Lin Wang
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Chi-Lin Kuo
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Floor 3, No. 17, Xuzhou Rd., Zhongzheng District, Taipei, Taiwan. .,Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan.
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Nagoshi N, Tsuji O, Okada E, Fujita N, Yagi M, Tsuji T, Nakamura M, Matsumoto M, Watanabe K. Clinical indicators of surgical outcomes after cervical single open-door laminoplasty assessed by the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire. Spinal Cord 2019; 57:644-651. [DOI: 10.1038/s41393-019-0258-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/19/2019] [Accepted: 01/24/2019] [Indexed: 11/09/2022]
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Surgical Treatment of Cervical Spondylotic Myelopathy in the Elderly: Outcomes in Patients Aged 80 Years or Older. Spine (Phila Pa 1976) 2018; 43:E1430-E1436. [PMID: 29916956 DOI: 10.1097/brs.0000000000002751] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective multicenter study. OBJECTIVE We aimed to assess the outcomes following posterior cervical decompression for cervical spondylotic myelopathy (CSM) in a large sample of patients older than 80 years. SUMMARY OF BACKGROUND DATA Although age is a predictor of surgical outcomes for CSM, most previous studies have only investigated the effect of age for patients aged 65 to 75 years, and surgical outcomes remain unclear for older patients. METHODS Patients older than 50 years who underwent posterior cervical decompression for CSM were enrolled from 17 institutions. The patients were grouped into a young-old group (<80 yrs old) and an old-old group (≥80 yrs). Clinical information, comorbidities, perioperative complications, Japanese Orthopaedic Association (JOA) scores, Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), visual analog scale (VAS) scores, and radiographic parameters were compared between the two groups. All patients were followed for at least 1 year after surgery. RESULTS The young-old and old-old groups included 491 and 77 patients, respectively. The JOA score and quality of life measured by JOACMEQ improved significantly after surgery in both groups. Compared with the young-old group, the old-old group had lower preoperative JOA scores (9.6 vs. 11.0), lower final JOA scores (12.6 vs. 14.0), and lower recovery rates (42% vs. 50%). However, there were no significant differences in perioperative complications or in the VAS scores at the final assessments. The old-old group had a higher mean preoperative sagittal Cobb angle at C2-C5, though this was not statistically significant postoperatively. CONCLUSION Posterior decompression surgery is safe and beneficial for patients older than 80 years with CSM, despite having a more limited neurological recovery compared with younger patients. LEVEL OF EVIDENCE 3.
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Wang Y, Wang W, Zhu M, Wang J, Zhou Y, Huang K, Wang J, Teng H. Cervical spondylotic myelopathy patients with prior cerebral infarction: Clinical characteristics, surgical outcomes and prognostic value of "prior cerebral infarction". Clin Neurol Neurosurg 2018; 175:34-39. [PMID: 30316067 DOI: 10.1016/j.clineuro.2018.09.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 09/18/2018] [Accepted: 09/23/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To investigate the clinical characteristics and surgical outcomes of patients with cervical spondylotic myelopathy (CSM) and prior cerebral infarction (CI); to identify whether "prior CI" correlates with poor surgical outcomes. PATIENTS AND METHODS Twenty-two patients with CSM and prior CI were retrospectively reviewed and included as the CI group while 100 CSM patients without CI were included as the control group (matched for gender, age, symptom duration and surgical approach). Extensive demographic and surgery-related data for patients in both groups were collected and compared. Multivariate logistic regression analysis was performed to assess all potential factors affecting surgical outcomes. RESULTS Compared to the control group, the CI group had the following: significantly higher percentages of hypertension, "progressive myelopathy", "rapid progressive myelopathy" and "intramedullary T2-weighted hyperintensity on MRI"; lower mean "preoperative mJOA score" and "postoperative mJOA score"; higher percentages of "preoperative mJOA score ≤11″ and "recovery rate of mJOA score <50%". In the CI group, 14 patients had CI within 6 months before CSM, and their percentage of "rapid progressive myelopathy" was higher than that of patients who had CI over 6 months before CSM. Logistic regression analysis showed that smoking, "symptom duration ≥12 months", "T2-weighted hyperintensity" and "prior CI" correlated with poor surgical outcome. CONCLUSION Rapid progressive myelopathy with advanced neurological impairment and "intramedullary T2-weighted hyperintensity" are common in patients with CSM and prior CI. Surgical outcomes in these patients are poorer than those of ordinary CSM patients. "Prior CI" is a risk factor for predicting poor surgical outcomes.
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Affiliation(s)
- Yu Wang
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, PR China
| | - Wangfei Wang
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, PR China
| | - Minyu Zhu
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, PR China
| | - Jing Wang
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, PR China
| | - Yang Zhou
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, PR China
| | - Kelun Huang
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, PR China
| | - Jianhong Wang
- Department of Orthopedics, Yuhuan County People's Hospital, Taizhou, 318000, PR China
| | - Honglin Teng
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, PR China.
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Short-term outcomes following posterior cervical fusion among octogenarians with cervical spondylotic myelopathy: a NSQIP database analysis. Spine J 2018; 18:1603-1611. [PMID: 29454135 DOI: 10.1016/j.spinee.2018.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/24/2018] [Accepted: 02/06/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Degenerative changes in the cervical spine occur in an age-dependent manner. As the US population continues to age, the incidence of age-dependent, multilevel, degenerative cervical pathologies is expected to increase. Similarly, the average age of patients with cervical spondylotic myelopathy (CSM) will likely trend upward. Posterior cervical fusion (PCF) is often the treatment modality of choice in the management of multilevel cervical spine disease. Although outcomes following anterior cervical fusion for degenerative disease have been studied among older patients (aged 80 years and older), it is unknown if these results extend to octogenarian patients undergoing PCF for the surgical management of CSM. PURPOSE The present study aimed to quantify surgical outcomes following PCF for the treatment of CSM among the octogenarian patient population compared with patients younger than 80 years old. STUDY DESIGN/SETTING This was a retrospective study that used the National Surgical Quality Improvement Program (NSQIP). PATIENT SAMPLE The sample included patients aged 60-89 who had CSM and who underwent PCF from 2012 to 2014. OUTCOME MEASURES The outcome measures were multimorbidity, prolonged length of stay (LOS), discharge disposition (to home or skilled nursing/rehabilitation facility), 30-day all-cause readmission, and 30-day reoperation. METHODS The NSQIP database was queried for patients with CSM (International Classification of Disease, Ninth Revision, Clinical Modification code 721.1) aged 60-89 who underwent PCF (Current Procedural Terminology code 22600) from 2012 to 2014. Cohorts were defined by age group (60-69, 70-79, 80-89). Data were collected on gender, race, elective or emergent status, inpatientor outpatient status, where patients were admitted from (home vs. skilled nursing facility), American Society of Anesthesiologists class, comorbidities, and single- or multilevel fusion. After controllingfor these variables, logistic regression analysis was used to compare outcome measures in the different age groups. RESULTS A total of 819 patients with CSM who underwent PCF (416 aged 60-69, 320 aged 70-79, and 83 aged 80-89) were identified from 2012 to 2014. Of the PCF procedures, 79.7% were multilevel. There were no significant differences in the odds of multimorbidity, prolonged LOS, readmission, or reoperation when comparing octogenarian patients with CSM with patients aged 60-69 or 70-79. Patients aged 60-69 and 70-79 were significantly more likely to be discharged to home than patients over 80 (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.8-10.4, p<.0001, and OR 2.7, 95% CI 1.1-6.4, p=.0005, respectively). CONCLUSIONS Compared with patients aged 60-69 and 70-79, octogenarian patients with CSM were significantly more likely to be discharged to a location other than home following PCF. After controlling for patient comorbidities and demographics, 80- to 89-year-old patients with CSM who underwent PCF did not differ in other outcomes when compared with the other age cohorts. These results can improve preoperative risk counseling and surgical decision-making.
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The Feature of Clinical and Radiographic Outcomes in Elderly Patients With Cervical Spondylotic Myelopathy: A Prospective Cohort Study on 1025 Patients. Spine (Phila Pa 1976) 2018; 43:817-823. [PMID: 29016440 DOI: 10.1097/brs.0000000000002446] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective cohort study. OBJECTIVE The purpose of this study was to compare the surgical outcomes between nonelderly and elderly patients with cervical spondylotic myelopathy (CSM) and to characterize the preoperative symptoms and postoperative residual symptoms in elderly patients. SUMMARY OF BACKGROUND DATA Age at the time of surgery influences the surgical outcome. However, no report has elucidated residual symptoms after surgery in elderly patients with CSM. We designed a large-scale cohort study examining the surgical outcomes of CSM in elderly patients from a single surgery. METHODS A total of 1025 consecutive patients with CSM (642 men and 383 women; mean age, 64.4 yr; range, 23-93 yr) who underwent laminoplasty were included. Patients were divided into three groups based on age: nonelderly (<65 yr), young-old (65-74 yr), and old-old (≥75 yr), and the number of patients in each group was 488, 329, and 208, respectively. The pre- and postoperative neurological statuses were evaluated using the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. The recovery rate (RR) of each function was compared among the three groups. Radiographic data including alignment and range of motion were also assessed. RESULTS The mean preoperative JOA scores of motor function of the lower extremity in nonelderly, young-old, and old-old groups were 2.8, 2.2, and 1.6, respectively (P < 0.0001). Elderly patients showed significantly lower JOA scores for bladder function than nonelderly patients (2.7, 2.5, and 2.2, P < 0.0001). Cervical lordosis in the neutral position increased gradually with age. Total range of motion decreased with increasing age. After surgery, the mean RRs of motor function of the lower extremity were 57.7%, 38.6%, and 24.0%, respectively. Gait disturbance significantly increased with age (P < 0.0001). CONCLUSION Postoperative gait disturbance persisted more than other symptoms in elderly patients than in nonelderly patients. LEVEL OF EVIDENCE 2.
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Fehlings MG, Tetreault LA, Kurpad S, Brodke DS, Wilson JR, Smith JS, Arnold PM, Brodt ED, Dettori JR. Change in Functional Impairment, Disability, and Quality of Life Following Operative Treatment for Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis. Global Spine J 2017; 7:53S-69S. [PMID: 29164033 PMCID: PMC5684851 DOI: 10.1177/2192568217710137] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES The primary objective of this systematic review was to define the change in impairment, disability, and pain following surgical intervention in patients with degenerative cervical myelopathy (DCM). Secondary objectives included to assess the impact of preoperative disease severity and duration of symptoms on outcomes and to summarize complications associated with surgery. METHODS A systematic literature search was conducted to identify prospective studies evaluating the effectiveness and safety of operative treatment in patients with DCM. Outcomes of interest were functional status, disability, pain, and complications. The quality of each study was evaluated using the Newcastle-Ottawa Scale, and the strength of the overall body of evidence was rated using guidelines outlined by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. RESULTS Of the 385 retrieved citations, 32 met inclusion criteria and are summarized in this review. Based on our results, pooled standard mean differences showed a large effect for improvement in Japanese Orthopaedic Association or modified Japanese Orthopaedic Association score from baseline at short-, medium-, and long-term follow-up: 6 to 12 months (1.92; 95% confidence interval [CI] = 1.41 to 2.43), 13 to 36 months (1.40; 95% CI = 1.12 to 1.67), and ≥36 months (1.92; 95% CI = 1.14 to 2.69) (moderate evidence). Surgery also resulted in significant improvements in Nurick, Neck Disability Index, and Visual Analogue Scale scores (low to very low evidence). The cumulative incidence of complications was low (14.1%; 95% CI = 10.1% to 18.2%). CONCLUSION Surgical intervention for DCM results in significant improvements in functional impairment, disability, and pain and is associated with an acceptably low rate of complications.
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Affiliation(s)
- Michael G. Fehlings
- Toronto Western Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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Takeshima Y, Matsuoka R, Nakagawa I, Nishimura F, Nakase H. Surgical Outcome of Laminoplasty for Cervical Spondylotic Myelopathy in an Elderly Population - Potentiality for Effective Early Surgical Intervention: A Meta-analysis. Neurol Med Chir (Tokyo) 2017; 57:366-373. [PMID: 28529246 PMCID: PMC5566709 DOI: 10.2176/nmc.ra.2016-0302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A systematic review and meta-analysis was conducted to determine differences in surgical outcomes of laminoplasty for cervical spondylotic myelopathy (CSM) between elderly and non-elderly patients. PubMed and Google Scholar searches were performed using several key words and phrases related to cervical laminoplasty in elderly populations. Included studies were written in English, addressed laminoplasty for cervical spondylotic myelopathy, and evaluated outcomes of the treatment. Statistical analysis was performed using a random-effect model. The heterogeneity of the studies was assessed using Cochran's Q statistic and I2 statistic, and a funnel plot was constructed to evaluate publication bias. The search initially identified 255 articles on this topic. Nine clinical studies that met all inclusion criteria were included in the meta-analysis. A total of 1817 patients in these studies underwent cervical laminoplasty. Elderly patients had lower preoperative and postoperative Japanese Orthopedic Association (JOA) scores, and lower recovery rates based on JOA scores. Shorter operation times and reductions in intraoperative blood loss were found in the elderly group compared to the non-elderly group. The incidence of C5 palsy was not different between these groups. We here report the differences in surgical outcomes of laminoplasty for CSM through systematic review and meta-analysis. This report found poor surgical outcomes and lower preoperative JOA scores in elderly patients. Therefore, early surgical intervention may be recommended in elderly patients with CSM.
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Affiliation(s)
| | - Ryuta Matsuoka
- Department of Neurosurgery, Nara Medical University School of Medicine
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University School of Medicine
| | | | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University School of Medicine
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Complications and Mortality Following One to Two-Level Anterior Cervical Fusion for Cervical Spondylosis in Patients Above 80 Years of Age. Spine (Phila Pa 1976) 2017; 42:E509-E514. [PMID: 28441681 DOI: 10.1097/brs.0000000000001876] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective database review. OBJECTIVE The aim of this study was to determine the complication and mortality rates in patients 80 years of age and older who were treated with anterior cervical fusion surgery and to compare these rates against those of other elderly patients. SUMMARY OF BACKGROUND DATA Cervical spondylosis is frequently observed in the elderly and is the most common cause of myelopathy in older adults. With increasing life expectancies, a greater proportion of patients are being treated with spine surgery at a later age. Limited information is available regarding outcomes following anterior cervical fusion surgery in patients 80 years of age or older. METHODS Medicare data from the PearlDiver Database (2005-2012) were queried for patients who underwent primary one to two-level anterior cervical spine fusion surgeries for cervical spondylosis. After excluding patients with prior spine metastasis, bone cancer, spine trauma, or spine infection, this cohort was divided into two study groups: patients 65 to 79 (51,808) and ≥80 years old (5515) were selected. A cohort of matched control patients was selected from the 65 to 79-year-old and 90-day complication rates and 90-day and 1-year mortality rates were compared between cohorts. RESULTS The proportion of patients experiencing at least one major medical complication was relatively increased by 53.4% in patients aged ≥80 years [odds ratio (OR) 1.63]. Patients 80 years of age or older were more likely to experience dysphagia (OR 2.16), reintubation (OR 2.34), and aspiration pneumonitis (OR 3.17). Both 90-day (OR: 4.34) and 1-year (OR 3.68) mortality were significantly higher in the ≥80 year cohort. CONCLUSION Patients 80 years of age or older are more likely to experience a major medical complication or mortality following anterior cervical fusion for cervical spondylosis than patients 65 to 79 years old. Dysphagia, aspiration pneumonitis, and reintubation rates are also significantly higher in patients 80 years of age or older. Although complication rates may be higher in this patient population, carefully selected patients could potentially derive much benefit from surgery and should not be screened out solely on the basis of age. LEVEL OF EVIDENCE 4.
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González-Bonet LG, Tarazona-Santabalbina FJ, Lizán Tudela L. Neurocirugía en el paciente mayor: neurocirugía geriátrica. Neurocirugia (Astur) 2016; 27:155-66. [DOI: 10.1016/j.neucir.2015.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 10/15/2015] [Accepted: 11/03/2015] [Indexed: 01/18/2023]
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Madhavan K, Chieng LO, Foong H, Wang MY. Surgical outcomes of elderly patients with cervical spondylotic myelopathy: a meta-analysis of studies reporting on 2868 patients. Neurosurg Focus 2016; 40:E13. [DOI: 10.3171/2016.3.focus1657] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE
Cervical spondylotic myelopathy usually presents in the 5th decade of life or later but can also present earlier in patients with congenital spinal stenosis. As life expectancy continues to increase in the United States, the preconceived reluctance toward operating on the elderly population based on older publications must be rethought. It is a known fact that outcomes in the elderly cannot be as robust as those in the younger population. There are no publications with detailed meta-analyses to determine an acceptable level of outcome in this population. In this review, the authors compare elderly patients older than 75 years to a nonelderly population, and they discuss some of the relevant strategies to minimize complications.
METHODS
In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors performed a PubMed database search to identify English-language literature published between 1995 and 2015. Combinations of the following phrases that describe the age group (“elderly,” “non-elderly,” “old,” “age”) and the disease of interest as well as management (“surgical outcome,” “surgery,” “cervical spondylotic myelopathy,” “cervical degenerative myelopathy”) were constructed when searching for relevant articles. Two reviewers independently assessed the outcomes, and any disagreement was discussed with the first author until it was resolved. A random-effects model was applied to assess pooled data due to high heterogeneity between studies. The mean difference (MD) and odds ratio were calculated for continuous and dichromatic parameters, respectively.
RESULTS
Eighteen studies comprising elderly (n = 1169) and nonelderly (n = 1699) patients who received surgical treatment for cervical spondylotic myelopathy were included in this meta-analysis. Of these studies, 5 were prospective and 13 were retrospective. Intraoperatively, both groups required a similar amount of operation time (p = 0.35). The elderly group had lower Japanese Orthopaedic Association (JOA) scores (MD −1.36, 95% CI −1.62 to −1.09; p < 0.00001) to begin with compared with the nonelderly group. The nonelderly group also had a higher postoperative JOA score (MD −1.11, 95% CI −1.44 to −0.79; p < 0.00001), therefore demonstrating a higher recovery rate from surgeries (MD −11.98, 95% CI −16.16 to −7.79; p < 0.00001). The length of stay (MD 4.14, 95% CI 3.54–4.73; p < 0.00001) was slightly longer in the elderly group. In terms of radiological outcomes, the elderly group had a smaller postoperative Cobb angle but a greater increase in spinal canal diameter compared with the nonelderly group. The complication rates were not significant.
CONCLUSIONS
Cervical myelopathy is a disease of the elderly, and age is an independent factor for recovery from surgery. Postoperative and long-term outcomes have been remarkable in terms of improvement in mobility and independence requiring reduced nursing care. There is definitely a higher potential risk while operating on the elderly population, but no significant difference in the incidence of postoperative complications was noted. Withholding surgery from the elderly population can lead to increased morbidity due to rapid progression of symptoms in addition to deconditioning from lack of mobility and independence. Reduction in operative time under anesthesia, lower blood loss, and perioperative fluid management have been shown to minimize the complication rate. The authors request that neurosurgeons weigh the potential benefit against the risks for every patient before withholding surgery from elderly patients.
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Spinal Disorders as a Cause of Locomotive Syndrome: The Influence on Functional Mobility and Activities of Daily Living. Clin Rev Bone Miner Metab 2016. [DOI: 10.1007/s12018-016-9213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Surgical Treatment Assessment of Cervical Laminoplasty Using Quantitative Performance Evaluation in Elderly Patients: A Prospective Comparative Study in 505 Patients With Cervical Spondylotic Myelopathy. Spine (Phila Pa 1976) 2016; 41:757-63. [PMID: 26583475 DOI: 10.1097/brs.0000000000001313] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective cohort study. OBJECTIVE The purpose of this study was to compare surgical outcomes between non-elderly and elderly patients with cervical spondylotic myelopathy (CSM) who underwent laminoplasty. SUMMARY OF BACKGROUND DATA Since age at the time of surgery influences the surgical outcome, we designed a large-scale cohort study to examine the surgical outcome for CSM from a single operative procedure used exclusively in elderly patients. METHODS A total of 505 consecutive patients with CSM (311 men; 194 women) were prospectively enrolled. The mean age was 66.6 years (range, 41-91), and the average postoperative follow-up period was 26.5 ± 12.5 months. Patients were divided into three groups according to age: non-elderly (<65 yr, n = 201), young-old (65-74 yr, n = 186), and old-old (≥75 yr, n = 118). Pre- and postoperative neurological status was evaluated using the Japanese Orthopaedic Association scoring system for cervical myelopathy (JOA score) and quantifiable tests-the 10-s grip and release test (10-s G&R test) and the 10-s step test. RESULTS Mean achieved JOA scores in non-elderly, young-old, and old-old groups were 3.1, 3.2, and 3.0, respectively, with no significant difference among three groups (P = 0.5735). Mean preoperative 10-s G&R test results were 17.3, 14.4, and 13.0, respectively, indicating a significant decrease with increasing age, whereas postoperative results significantly improved in all groups (21.0, 17.9, and 16.3, respectively). Similarly, the 10-s step test significantly decreased with age, with preoperative scores of 14.3, 11.5, and 8.6, respectively, whereas postoperative scores improved to 17.3, 14.9, and 12.5, respectively. The three groups showed no significant difference in the rate of postoperative complications. CONCLUSION Elderly patients adequately recovered from laminoplasty in terms of achieved JOA score, the 10-s G&R test, and the 10-s step test. Therefore, laminoplasty for CSM is beneficial in elderly patients. LEVEL OF EVIDENCE 2.
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Kuperman EF, Schweizer M, Joy P, Gu X, Fang MM. The effects of advanced age on primary total knee arthroplasty: a meta-analysis and systematic review. BMC Geriatr 2016; 16:41. [PMID: 26864215 PMCID: PMC4750247 DOI: 10.1186/s12877-016-0215-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/01/2016] [Indexed: 12/02/2022] Open
Abstract
Background Total knee arthroplasty is an effective treatment when nonsurgical treatments fail, but it is associated with risk of complications which may be increased in advanced age. The purpose of this study was to quantify age-related differences in perioperative morbidity and mortality after total knee arthroplasty through systematic review of existing literature. Methods PubMed, the Cochrane database of systematic reviews, Scopus, and clinicaltrials.gov, were queried for relevant studies that compared primary total knee arthroplasty outcomes of mortality, myocardial infarction (MI), deep vein thrombosis (DVT), pulmonary embolism (PE) and functional status, of geriatric patients (>75 years old) with a younger control group (<65 years old). Pertinent journals and reference lists were hand searched. Eligibility criteria included all articles except case reports, meta-analyses, and systematic reviews. Two authors independently extracted data from each paper. Article quality was assessed using the Newcastle-Ottawa Scale. Results Twenty-two studies were included. Geriatric patients had higher rates of mortality, MI, DVT, and length of stay in older compared to younger patients, however the absolute magnitude of these increases were small. The increase in mortality may have reflected decreased life expectancy in the geriatric populations as opposed to mortality specifically due perioperative risk. There were no differences in PE incidence and improvement in pain and functional status was equal in older and younger patients. Existing studies were limited by non-randomized patient selection, as well as variation in definitions and methodology. Conclusions Existing data supports offering primary total knee arthroplasty to select geriatric patients, although the risk of complications may be increased. Much of the data was of poor quality. Future prospective studies are needed to better identify risks and benefits of total knee arthroplasty so that patients and surgeons can make informed decisions. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0215-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ethan F Kuperman
- Department of Internal Medicine, University of Iowa, Carver College of Medicine, SE 622 GH 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Marin Schweizer
- Department of Internal Medicine, University of Iowa, Carver College of Medicine, SE 622 GH 200 Hawkins Drive, Iowa City, IA, 52242, USA.,Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health System, Iowa City, IA, USA.,Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Parijat Joy
- Department of Internal Medicine, University of Iowa, Carver College of Medicine, SE 622 GH 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Xiaomei Gu
- Health Sciences Clinical Education Librarian, Hardin Library of the Health Sciences, University of Iowa, Iowa City, IA, USA.
| | - Michele M Fang
- Department of Internal Medicine, University of Iowa, Carver College of Medicine, SE 622 GH 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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O'Lynnger TM, Zuckerman SL, Morone PJ, Dewan MC, Vasquez-Castellanos RA, Cheng JS. Trends for Spine Surgery for the Elderly: Implications for Access to Healthcare in North America. Neurosurgery 2015; 77 Suppl 4:S136-41. [PMID: 26378351 DOI: 10.1227/neu.0000000000000945] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The proportion of the population over age 65 in the United States continues to increase over time, from 12% in 2000 to a projected 20% by 2030. There is an associated rise in the prevalence of degenerative spinal disorders with this aging population. This will lead to an increase in demand for both nonsurgical and surgical treatment for these disabling conditions, which will stress an already overburdened healthcare system. Utilization of spinal procedures and services has grown considerably. Comparing 1999 to 2009, lumbar epidural steroid injections have increased by nearly 900,000 procedures performed per year, while physical therapy evaluations have increased by nearly 1.4 million visits per year. We review the literature regarding the cost-effectiveness of spinal surgery compared to conservative treatment. Decompressive lumbar spinal surgery has been shown to be cost-effective in several studies, while adult spinal deformity surgery has higher total cost per quality-adjusted life year gained in the short term. With an aging population and unsustainable healthcare costs, we may be faced with a shortfall of beneficial spine care as demand for spinal surgery in our elderly population continues to rise. ABBREVIATION QALY, quality-adjusted life year.
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Affiliation(s)
- Thomas M O'Lynnger
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Chen J, Liu Z, Zhong G, Qian L, Li Z, Chen B, Lao L, Han T. Surgical treatment for cervical spondylotic myelopathy in elderly patients: A retrospective study. Clin Neurol Neurosurg 2015; 132:47-51. [DOI: 10.1016/j.clineuro.2015.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 01/25/2015] [Accepted: 02/16/2015] [Indexed: 10/23/2022]
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The Michel Benoist and Robert Mulholland Yearly European Spine Journal Review: a survey of the "surgical and research" articles in the European Spine Journal, 2013. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:9-18. [PMID: 24384830 DOI: 10.1007/s00586-013-3126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Indexed: 10/25/2022]
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