Surgical Outcomes of Cervical Spine Surgery in Elderly Patients

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STUDY DESIGN: Prospective multicenter cohort study.Objective. To evaluate age-related differences in neurological, functional, and quality-of-life outcomes after surgery for degenerative cervical myelopathy (DCM) using both clinician-based and patient-reported outcome measures (PROMs). SUMMARY OF BACKGROUND DATA: As populations age, the number of elderly patients undergoing cervical spine surgery is increasing. Although previous studies have investigated surgical outcomes in elderly patients with DCM, most have relied primarily on clinician-based assessments, and comprehensive prospective evaluations incorporating PROMs remain limited. METHODS: A total of 875 patients with DCM who underwent cervical spine surgery at 10 Japanese institutions were prospectively enrolled and completed 2-year follow-up. Patients were divided into elderly (≥75 y, n=281) and non-elderly (<75 y, n=594) groups. Clinical outcomes included the Japanese Orthopaedic Association (JOA) score, Short Form-36 (SF-36), Neuropathic Pain Symptom Inventory (NPSI), and Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). Multivariable analyses were performed to adjust for demographic, clinical, surgical, and radiographic confounders. RESULTS: The elderly group demonstrated significantly lower preoperative JOA scores and smaller postoperative improvement (ΔJOA) than the non-elderly group. Nevertheless, elderly patients achieved the minimum clinically important difference (MCID) for JOA. In contrast, improvement in SF-36 Physical Component Summary (PCS) scores was significantly smaller in elderly patients and did not reach the established MCID threshold. Improvement in upper- and lower-extremity pain and numbness was also significantly reduced. Multivariable logistic regression demonstrated that age ≥75 years was independently associated with lower effectiveness rates for upper-extremity function (OR 0.64, P=0.016) and lower-extremity function (OR 0.37, P<0.001) on the JOACMEQ. No significant age-related differences were observed in mental health, neuropathic pain, or perioperative complication rates. CONCLUSION: Cervical spine surgery in elderly patients with DCM is safe and provides clinically meaningful neurological improvement. However, recovery of patient-reported physical function, particularly upper- and lower-extremity function, remains limited compared with younger patients. These findings suggest that clinician-based neurological assessments alone may underestimate residual disability and highlight the importance of incorporating PROMs into the evaluation of surgical outcomes in elderly patients with DCM. LEVEL OF EVIDENCE: 2.

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