Older DCM Patients Face Higher risk of Limited Neurological Recovery After Surgery,Japanese Study Finds
TOKYO – A new multi-institutional study from Japan indicates that advanced age is a important,independent predictor of limited neurological improvement following posterior decompression surgery for degenerative cervical myelopathy (DCM),a condition impacting the spinal cord in the neck. The findings, published recently, offer crucial insight for patient counseling and surgical planning.
DCM, caused by age-related wear and tear on the cervical spine, compresses the spinal cord and can lead to a range of debilitating symptoms including weakness, numbness, and difficulty with coordination. While posterior decompression surgery aims to relieve this pressure, outcomes vary considerably.This research, involving 868 patients across 17 Japanese institutions, sought to pinpoint factors associated with less favorable results, a critical step toward optimizing care for those affected. Approximately 80,000 people are diagnosed with DCM annually in the United States alone, and as the population ages, understanding predictors of surgical success becomes increasingly vital. Identifying patients at higher risk of limited recovery allows for more realistic expectations and potentially option or adjunctive treatment strategies.
researchers categorized patients into three groups – fair, moderate, and good – based on their Japanese orthopedic association (JOA) recovery rate following surgery. Patients were followed for over one year.The fair group exhibited a recovery rate below 22.2% (averaging 6.2% ± 13.7%),the moderate group ranged from 22.3% to 77.1% (50.1% ± 15.0%), and the good group exceeded 77.2% (90.6% ± 8.3%).
Initial analysis revealed a statistically significant difference in the prevalence of diabetes mellitus across the three groups (26.4% in the fair group, 23.0% in the moderate group, and 14.1% in the good group; p = 0.03). However, after employing multinominal logistic regression, old age emerged as the sole significant independent predictor of poorer outcomes. Specifically,patients in the fair outcome group were 1.62 times more likely to be older compared to those in the good outcome group (95% confidence interval: 1.27-2.07; p < 0.01). Similarly, older patients were 1.35 times more likely to fall into the fair outcome group compared to the moderate outcome group (95% confidence interval: 1.15-1.59; p < 0.01). The study concludes that advanced age may independently contribute to a failure of neurological improvement after posterior decompression surgery for DCM. Further research is needed to explore the underlying mechanisms driving this association and to develop strategies to mitigate the impact of age on surgical outcomes.