Clinical and Radiologic Results of Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy in Elderly Patients with T2-Weighted Increased Signal Intensity

OBJECTIVE: To investigate clinical and radiologic results of anterior cervical discectomy and fusion for cervical spondylotic myelopathy in elderly patients with T2-weighted increased signal intensity (ISI), focusing specifically on the quantitative analysis of ISI. METHODS: We retrospectively reviewed 88 patients with cervical spondylotic myelopathy with ISI who underwent anterior cervical discectomy and fusion with a minimum 1-year follow-up. Patients were divided into 2 groups: patients older than 65 (elderly group, 36 patients) or younger (young group, 52 patients). The Japanese Ortho-paedic Association (JOA) score was used to evaluate the neurologic status. The signal change ratio (SCR) was defined as the grayscale of ISI region divided by that at C7-T1 disc level. The C2-C7 sagittal alignment, range of motion, SCR, and ISI length were measured. RESULTS: There was no statistically significant difference between the 2 groups in C2-C7 sagittal alignment and range of motion. However, the JOA score at 1-year follow-up and recovery rate in elderly group were significantly lower than in young group (P < 0.001). SCR and ISI length were significantly greater in elderly group than in young group, whereas their changes were significantly lower in elderly group (P < 0.05). Multivariate logistic regression analysis showed that an older age, a lower preoperative JOA score, a greater preoperative SCR, and a longer preoperative ISI length at 1-year follow-up were negatively correlated with the clinical outcomes in the elderly group (P < 0.05). CONCLUSIONS: Compared with young patients with ISI, the elderly patients had a lower preoperative JOA score, a greater preoperative SCR, and a longer preoperative ISI length, indicating poor surgical outcomes.