The Impact of Age on Patient-Reported Outcome Measures After Posterior Cervical Decompression and Fusion

Retrospective cohort. Evaluate the impact of age among patients undergoing PCDF grouped by decades of age. Cervical degenerative disease disproportionately affects the elderly and is often treated with posterior cervical decompression and fusion (PCDF)-the impact of age on surgical and patient-reported outcomes (PROMs) remains controversial. Adult patients 50 to 79 years old who underwent primary elective PCDF were retrospectively identified through Structured Query Language (SQL) search. Demographic and surgical data were verified with manual chart review. PROMs evaluated included neck disability index (NDI), visual analog scale (VAS) neck and arm, modified Japanese Orthopaedic Association (mJOA), and Short-Form 12 mental (MCS) and physical (PCS) scores. Patients were excluded if incomplete PROMs at preoperative and one-year postoperative timepoints or underwent PCDF for tumor/trauma/infection/revision. Patients were divided by decade (50-59, 60-69, 70-79&#xa0;yr) and statistical analysis set alpha=0.05. Totally, 194 patients were included (ages 50-59-65; 60-69-87; 70-79-42). CCI (2.40 vs. 3.62 vs. 4.93; P <0.001) and levels fused (3.37 vs. 4.25 vs. 4.64; P =0.005) increased with age. Despite these findings, the degree of improvement did not differ between groups for any PROMs. VAS neck and NDI scores were better at preoperative, 3-, 6-, and 12-month postoperative timepoints among the older decades compared with the younger decades ( P <0.05). Preoperative and one-year postoperative MCS scores were higher in older age groups. All other MCS comparisons along with VAS arm, mJOA, and PCS did not differ between groups. Multivariable regression identified the 60 to 69 decade (estimate: -4.28; P =0.025) as independently associated with better one-year NDI whereas the 70 to 79 decade was independently associated with both better one-year NDI (estimate: -6.93; P =0.025) and one-year MCS (estimate: 8.53; P =0.01). Patients across older decades achieve similar improvement in PROMs following PCDF and may have better neck pain-related PROMs both preoperatively and postoperatively. These findings suggest that older patients, despite having more comorbidities and more extensive surgery, can receive similar mental, pain-related, and functional benefits from PCDF compared with younger patients.