Do Elderly Patients Achieve Comparable Functional and Quality-of-Life Improvements After Anterior Cervical Discectomy and Fusion for Degenerative Cervical Myelopathy?

Study Design Retrospective cohort study. Objectives To compare pain, disability, and quality-of-life outcomes following anterior cervical discectomy and fusion (ACDF) between elderly and younger patients with degenerative cervical myelopathy (DCM). Methods A prospectively maintained institutional registry was reviewed for patients undergoing primary ACDF for DCM between 2005-2014. A total of 219 patients were stratified into Young (<70 years; n = 188) and Elderly (≥70 years; n = 31) cohorts. Patients undergoing surgery for trauma, infection, malignancy, or revision were excluded. Outcomes included VAS neck and limb pain, AAOS Neurogenic Symptoms and Neck Pain & Disability, Neck Disability Index, Japanese Orthopaedic Association score, and SF-36 Physical and Mental Component Summary scores, collected preoperatively and at 6 months and 2 years. Satisfaction and expectation fulfilment were assessed using anchor questions. Results Elderly patients had higher rates of hypertension ( P = .016), osteoarthritis ( P = .034), and longer length of stay ( P = .045). Baseline PROMs were comparable, except for higher preoperative limb pain in younger patients ( P = .027). At 6 months, younger patients showed greater improvement in limb pain ( P = .016), with no other differences. At 2 years, elderly patients had worse neck-related disability ( P = .043), lower physical component scores ( P = .035), and less improvement in neurogenic symptoms ( P = .039). Expectation fulfilment was lower in elderly patients (64.5% vs 80.3%, P = .049), while satisfaction rates were similar. Conclusions Elderly patients demonstrated smaller improvements in neurological symptoms, disability, and physical quality of life after ACDF, although both groups showed substantial improvement. These findings suggest that older age is associated with differences in recovery magnitude rather than likelihood of improvement.