Grant: Travel Awards - Institute Community Support

Introduction: 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. Methods: Of 757 patients enrolled in the prospective multicenter AOSpine CSM North America and International studies, 107 patients were identified as elderly (70 years or older) at the time of surgery. Outcomes were assessed between the adult and elderly groups at 6, 12, and 24 months including functional status and QOL scores (mJOA, SF-36). Statistical analysis was used to compare the groups after adjusting for the presence of comorbidities, cigarette smoking, number of operated levels, surgical approach, and baseline degree of impairment (mJOA). Results: The baseline impairment in the elderly group was significantly better than the younger group (p=<0.01), but both groups had similar change in scores at the 6, 12 and 24 month intervals. After covariate adjustment, the functional recovery in elderly patients was significantly worse at every interval. The physical QOL score between groups began similar, but the elderly group displayed less improvement over time. This was reflected in significantly worse scores after covariate adjustment. The mental QOL score began higher in the elderly group, however mean change was similar at 6 and 12 months. At 24 months, the elderly group had a lower mental QOL score, which was also present after covariate adjustment. Conclusions: In this combined dataset from 2 large prospectively collected multi-centre studies, the elderly group demonstrated significantly worse functional and QOL recovery when compared to the younger cohort after adjusting for the effect of co-morbidities, number of operated levels, surgical approach and baseline mJOA. Elderly patients with DCM should therefore be counseled appropriately regarding expectations of surgery.