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Intraoperative electroneurography in the assessment of the level of operation for cervical spondylotic myelopathy in the elderly

Department of Orthopaedic Surgery, Kochi Medical School, Kohasu Oko-cho, Nankoku City, Kochi 783-8505, Japan.

Correspondence should be sent to Dr T. Tani.

We treated 31 patients aged 65 years or more with cervical spondylotic myelopathy by microsurgical decompression and fusion at a single most appropriate level, in spite of MRI evidence of compression at several levels. Spinal cord potentials evoked at operation localised the level responsible for the principal lesion at C3-4 in 18 patients, C4-5 in 11 and at C5-6 in two. Despite the frequent coexistence of other age-related conditions, impairing ability to walk, the average Nurick grade improved from 3.5 before operation to 2.2 at a mean follow-up of 48 months. There was also good recovery of finger dexterity and sensitivity.

Operation at a single optimal level, as opposed to several, has the advantage of minimising complications, of particular importance in this age group.