TITLE:
Anterior and Posterior Approach Results for Treatment of Cervical Myelopathy in the Elderly: A 10-Year Experience in a Mexican Institution
AUTHORS:
Mauricio Daniel Sánchez-Calderón, María Elena Córdoba-Mosqueda, José Ramón Aguilar-Calderón, Carlos René Domínguez-Herz, Diego Ochoa-Cacique, Daniel Alejandro Vega-Moreno, Victor Andrés Reyes-Rodriguez, Ulises García-González, Abraham Ibarra-de la Torre, Rodrigo Efraín Hernández-Reséndiz
KEYWORDS:
Cervical Spine, Surgical Approach, Elderly, Cervical Myelopathy, Cervical Degenerative Spine Disease
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.11 No.7,
July
23,
2021
ABSTRACT: Introduction: Degeneration of the
cervical spine (CDSD) prevalence is nearly 90% by the 7th decade. This is the
first research that compares the outcomes between the Anterior Approach (AA)
and Posterior Approach (PA) to cervical myelopathy (CM) in the elderly. Materials
and Methods: A
retrospective observational study of electronic health records at the Hospital
Central Sur de Alta Especialidad (HCSAE), PEMEX from January 2010 to May 2020
with patients older than 60 years submitted to cervical surgery. For the
analysis we elaborated two groups according to the surgical approach: AA vs PA;
we analyzed the trans-operative behavior, the immediate outcome, and after 3
months, 6 months, and 1 year. Results: As a total of 145 patients, the
prevalence of CM in elderly was the 63.8% with a median age of 69 (64 - 75)
years. We found statistical differences in strength outcome only in the P3m (p
= 0.011), for sensitivity we found major
prevalence of affection in the PA group. We didn’t report a significant
difference in the Neck Disability Index (NDI) at all measures, but the PA
presented a major incapacity. The Nurick scale results were significant in all
stages (p . Discussion:
Patients show significant improvements in outcome measures with either anterior
or posterior surgery. Both approaches are highly efficacious in preventing
neurologic deterioration and in most cases improve neurological function with appropriate
postoperative management like rehabilitation, pain management, and psychological support. Conclusion: The patients submitted to surgical medullary decompression
presented a favorable outcome despite the age and the higher prevalence of
comorbidities; whereby we favor the surgical treatment in all patients in a
case-to-case selection to generate a positive impact on functional outcomes.