Microsurgery of the cervical spine in elderly patients Part 1: Surgery of degenerative disease

Summary

The results of microsurgery for degenerative disease of the cervical spine 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. In 60 patients microsurgical resection of the involved cervical disc and posterior osteophytes was performed followed by anterior fusion. Spondylectomy, microsurgical decompression and osteosynthesis was performed in 24 patients with multi-level cervical stenosis. A multitude of accompanying systemic diseases was present in almost all patients. Evaluation of the peri-operative risk profile of the patients was performed using the American Society of Anesthesiology (ASA) Grading of Physical Status Score.

In 82 patients a complete follow-up was available. Two 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 worse, and two patients (2%) died. Postoperative recovery was significantly correlated to the pre-operative neurological status. Neither age, nor the pre-operative ASA score had a significant influence on the postoperative outcome. The incidence of peri-operative systemic complications was significantly correlated to the pre-operative physical status of the patients according to the ASA score. No significant correlation towards an increase of peri-operative complications with higher grades of pre-operative neurological deficits or with increasing age of the patients could be found.

It is concluded, that surgery of degenerative disease of the cervical spine, even in advanced cases, and with aggressive forms of surgical treatment, can be performed in a safe and effective manner in elderly patients, resulting in a significant relief of pre-operative clinical symptoms and signs in the majority of patients.