P91. Surgical management of octogenarians with degenerative cervical myelopathy.

Degenerative cervical myelopathy (DCM) represents a collection of age-related degenerative processes of the cervical spine that can result in motor, sensory and autonomic dysfunction, leading to significant reductions in quality of life. Older individuals, and in particular octogenarians, with advanced myelopathy pose unique clinical challenges, as they may be severely compromised and while they may benefit from surgery, the extent of neurologic improvement may be unpredictable and the risk of adverse events may be higher than younger patients. The aim of this study was to better characterize outcomes following cervical spine surgery in octogenarians with advanced myelopathy. A retrospective analysis of a consecutively treated patients older than age 80 with degenerative cervical myelopathy who underwent cervical decompression surgery at a single institution over a 10-year period (2010-2019). A total of 57 patients. Nurick grade, mJOA scores, patient-reported satisfaction. All patients experienced myelopathic features and exhibited multi-level spinal cord compression on preoperative MRI. Surgical techniques employed were based on location of the compressive neural pathology, spinal alignment and the presence of segmental instability. The average followup duration was 3.50 ± 1.56 years. Paired t-tests and Wilcoxon-signed rank tests were used to compare Nurick and mJOA scores before and after surgery. Multiple preoperative clinical and radiographic variables were evaluated to assess their effect on postoperative outcome. A multivariate analysis of variants was employed to assess the significance of these variables. Fifty of 57 (88%) patients noted improvement in both Nurick grade and mJOA score postoperatively. The mean Nurick grade improved from 4.15 ± 0.21 to 2.02 ± 0.72 (p < 0.001, paired t-test; 95% CI -2.08 to -1.71). The mean mJOA score improved from 9.48 ± 1.31 to 14.50 ± 1.37 (p < 0.001, paired t-test; 95% CI 2.59 to 3.45). Eleven of 14 patients (78%) who were nonambulatory prior to surgery regained the ability to ambulate. Significant risk factors for the 12% of patients who did not improve included preoperative symptoms greater than 1 year, diabetes, residing in an assisted living environment, preoperative nonambulation. Notable factors not significantly affecting outcome included type of surgical procedure, number of levels of preoperative cord compression, or presence of myelomalacia. Adverse events requiring additional surgery occurred in 4 patients (8%), including anterior plate displacement in 1 patient, persistent dysphagia requiring temporary gastrostomy tube in 1 patient, and additional posterior surgery for instrumentation failure and development of kyphotic deformity. In comparison with a cohort of nonoctogenarians undergoing myelopathy surgery, adverse events and need for further surgery were not significantly different. Our study demonstrated that elderly patients with severe forms of DCM experienced significant improvement in neurological function following cervical decompression surgery. These improvements indicate that cervical decompression surgery is effective in this patient population and while consideration of the effect of age in elderly patients must always be given consideration, it is not a contraindication for surgery. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]