Laminoplasty for patients aged 75 years or older with cervical myelopathy/Authors' reply

To the Editor:

We read with interest the article by Ishii et al.1 To enable a better comparison with other studies and to indicate the true effect of surgery, the authors should have commented on the duration of symptoms and its correlation with outcomes. Patients who had a shorter duration of symptoms and milder myelopathy were reported to have significantly better postoperative neurological improvement based on the Japanese Orthopaedic Association (JOA) scoring system.2 Consistent with this finding, surgical outcomes and duration of symptoms were also reported to be correlated.3

O Berber, Z Harb, R Berber, Q Bismil

Department of Orthopaedics

St George's Hospital

London, United Kingdom

REFERENCES

1. Ishii M, Wada E, Ishii T, Kawai H, Kaneko N, Fuji T. Laminoplasty for patients aged 75 years or older with cervical myelopathy. J Orthop Surg (Hong Kong) 2008;16:211-4.

2. Aizawa T, Sato T, Sasaki H, Matsumoto F, Morozumi N, Kusakabe T, et al. Results of surgical treatment for thoracic myelopathy: minimum 2-year follow-up study in 132 patients. J Neurosurg Spine 2007;7:13-20.

3. Mastronardi L, Elsawaf A, Roperto R, Bozzao A, Caroli M, Ferrante M, et al. Prognostic relevance of the postoperative evolution of intramedullary spinal cord changes in signal intensity on magnetic resonance imaging after anterior decompression for cervical spondylotic myelopathy. J Neurosurg Spine 2007;7:615-22.

Authors' reply:

Age,1 duration of symptoms,2 severity of myelopathy,3 cervical alignment,4 and spinal cord signal change on magnetic resonance images5 have been reported to be prognostic. We only focused on age and postoperative clinical features to determine if surgery was justified. We could not investigate other prognostic factors from our data.

M Ishii

Department of Orthopaedic Surgery

Hoshigaoka Koseinenkin Hospital, Osaka, Japan

REFERENCES

1. Nagashima H, Morio Y, Yamashita H, Yamane K, Teshima R. Clinical features and surgical outcomes of cervical myelopathy in the elderly. Clin Orthop Relat Res 2006;444:140-5.

2. Yamazaki T, Yanaka K, Sato H, Uemura K, Tsukada A, Nose T. Cervical spondylotic myelopathy: surgical results and factors affecting outcome with special reference to age differences. Neurosurgery 2003;52:122-6.

3. Tanaka J, Seki N, Tokimura F, Doi K, Inoue S. Operative results of canal-expansive laminoplasty for cervical spondylotic myelopahty in elderly patients. Spine 1999;24:2308-12.

4. Suda K, Abumi K, Ito M, Shono Y, Kaneda K, Fujiya M. Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy. Spine 2003;28:1258-62.

5. Morio Y, Teshima R, Nagashima H, Nawata K, Yamasaki D, Nanjo Y. Correlation between operative outcomes of cervical compression myelopathy and MRI of the spinal cord. Spine 2001;26:1238-45.

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