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Background: The effect on functional and quality of life (QOL) outcomes of surgery in elderly degenerative cervical myelopathy (DCM) patients has not been definitively established. Objective: To evaluate the effect of older age on the functional and QOL outcomes after surgery in an international, multi-center cohort of patients with DCM. Methods: 107 patients aged over 70 years old (mean 75.6 ± 4.4 years) were enrolled in the AOSpine CSM-North America and International studies. A propensity-matched cohort of 107 patients was generated from the remaining 650 adults aged <70 years old (mean 56.3 ± 9.6 years), matched to gender, complexity of surgery, co-morbidities, and baseline functional impairment (modified Japanese Orthopedic Association scale (mJOA). Functional, disability, and QOL outcomes were compared at baseline and at two years post-operatively, along with peri-operative adverse events. Results: Both cohorts were equivalently matched. At two years, both cohorts showed significant functional improvement from the baseline but the magnitude was greater in the younger cohort (mJOA 3.8 (3.2–4.4) vs. 2.6 (2.0–3.3); p = 0.007). This difference between groups was also observed in the SF-36 physical component summary (PCS) and mental component summary (MCS) outcomes (p = <0.001, p = 0.007), but not present in the neck disability index (NDI) scores (p = 0.094). Adverse events were non-significantly higher in the elderly cohort (22.4% vs. 15%; p = 0.161). Conclusions: Elderly patients showed an improvement in functional and QOL outcomes after surgery for DCM, but the magnitude of improvement was less when compared to the matched younger adult cohort. An age over 70 was not associated with an increased risk of adverse events. [ABSTRACT FROM AUTHOR]

Surgical decompression has been shown to improve long-term function, disability and quality of life (QOL) in degenerative cervical myelopathy (DCM); however, the role of surgery, and the effect on functional and QOL outcomes, in elderly patients with DCM is controversial. To investigate the effect of older age (over 70) on the functional and QOL impairment and outcomes after DCM surgery compared to younger adults. Prospective, multicentre observational studies on the outcomes of surgery for DCM; the AO Spine CSM-North America and the CSM-International studies. A harmonized, combined dataset of 757 patients enrolled from both studies. Functional assessment was performed with the modified Japanese Orthopedic Association score (mJOA). QOL outcomes were measured by the SF-36 physical and mental component scores. Of 757 patients enrolled in both studies, 107 patients were identified as elderly (70 years or older) at the time of surgery. Outcomes and functional status were assessed at 6-, 12- and 24-month intervals. In addition to unadjusted univariate analyses, multiple linear regression was used to evaluate the effect of age ≥70 on change in outcome scores adjusting for diabetes, cardiac comorbidities, cigarette smoking, psychiatric disorders, number of operated levels, surgical approach and baseline mJOA. The baseline mJOA in the elderly group was significantly lower than the younger group (11.0 [95% CI 10.4-11.5] vs 12.9 [12.7-13.1]; p=<0.01). The SF-36 Physical Component Summary (PCS) score was no different (33.5 [31.8-35.1] vs 34.5 [33.8-35.2]; p=0.28) and the SF-36 Mental Component Summary (MCS) score was significantly higher in the elderly group (43.0 [40.6-45.5] vs 39.8 [38.7-40.8]; p=0.02). The unadjusted change in mJOA scores (dmJOA) were similar in both groups at 6 months (elderly 2.30 [1.71-2.88] vs younger 2.21 [2.02–2.40]; p=0.75), 12 months (2.79 [2.18-3.41] vs 2.50 [2.29-2.70]; p=0.30) and 24 months (2.63 [1.99–3.27] vs 2.71 [2.51-2.92]; p=0.77). However, after covariate adjustment, the coefficient for change at 6 months in the elderly group was -0.84 (p=<0.01), -0.74 at 12 months (p=<0.01) and -1.22 at 24 months (p=<0.01). The change in SF-36 physical scores (dPCS) were lower in the elderly group at 6 months (3.14 [1.46-4.81] vs 5.78 [5.07-6.48]; p=<0.01), 12 months (5.56 [3.86-7.26] vs 6.41 [5.67-7.16]; p=0.40) and 24 months (3.43 [1.37–5.49] vs 6.17 [5.40-6.94]; p=<0.01). The coefficient of change when adjusted at 6 months in the elderly group was -3.02 (p=<0.01), -1.16 at 12 months (p=0.27) and -3.65 at 24 months (p=<0.01). The change in SF-36 mental scores (dMCS) were not significantly different at 6 and 12 months (5.23 [2.40-8.06] vs 6.01 [5.05-6.97]; p=0.56, 5.96 [3.32-8.61] vs 6.18 [5.22-7.14]; p=0.87) but were significantly lower in the elderly group at 24 months (2.59 [-0.028–5.47] vs 5.96 [4.97 – 6.96]; p=0.01). The coefficient of change after adjustment at 6 months was -0.97 (p=0.50), -1.23 at 12 months (p=0.38) and -4.53 at 24 months (p=<0.01) in the elderly group. In this combined dataset from 2 large prospectively collected multicentre studies on DCM surgery, the group aged 70 or greater demonstrated significantly worse functional and QOL recovery when compared to the younger cohort after adjusting for the effect of comorbidities, number of operated levels, surgical approach and baseline mJOA. Elderly patients undergoing surgery for DCM should therefore be counseled appropriately regarding expectations of surgery. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Objectives: There are few contemporary, prospective multicenter series on the spectrum of acute adverse events and their relationship to long-term outcomes after traumatic spinal cord injury. The goal of this study is to assess the prevalence of adverse events after traumatic spinal cord injury and to evaluate the effects on long-term clinical outcome., Design: Multicenter prospective registry., Setting: Consortium of 11 university-affiliated medical centers in the North American Clinical Trials Network., Patients: Eight-hundred one spinal cord injury patients enrolled by participating centers., Interventions: Appropriate spinal cord injury treatment at individual centers., Measurements and Main Results: A total of 2,303 adverse events were recorded for 502 patients (63%). Penalized maximum logistic regression models were fitted to estimate the likelihood of neurologic recovery (ASIA Impairment Scale improvement ≥ 1 grade point) and functional outcomes in subjects who developed adverse events at 6 months postinjury. After accounting for potential confounders, the group that developed adverse events showed less neurologic recovery (odds ratio, 0.55; 95% CI, 0.32-0.96) and was more likely to require assisted breathing (odds ratio, 6.55; 95% CI, 1.17-36.67); dependent ambulation (odds ratio, 7.38; 95% CI, 4.35-13.06) and have impaired bladder (odds ratio, 9.63; 95% CI, 5.19-17.87) or bowel function (odds ratio, 7.86; 95% CI, 4.31-14.32) measured using the Spinal Cord Independence Measure subscores., Conclusions: Results from this contemporary series demonstrate that acute adverse events are common and are associated with worsened long-term outcomes after traumatic spinal cord injury.