Association Between Locomotive Syndrome and Dysphagia Following Posterior Subaxial Cervical Surgery in Older Patients With Degenerative Cervical Myelopathy

Aim: Both locomotive syndrome and dysphagia are important health concerns in older patients with degenerative cervical myelopathy (DCM). This study evaluated postoperative changes in locomotive syndrome stage and dysphagia risk and examined whether improvement in locomotive syndrome is associated with dysphagia status in older patients with DCM. Methods: We retrospectively reviewed patients aged ≥ 65 years who underwent posterior subaxial cervical surgery for DCM. Patient-reported outcomes were assessed preoperatively and at 6 months and 1 year postoperatively using the 25-question Geriatric Locomotive Function Scale and 10-item Eating Assessment Tool. Locomotive syndrome stage and dysphagia status, defined as an Eating Assessment Tool score ≥ 3, were compared over time and according to improvement in locomotive syndrome stage at 1 year. Results: Among 150 patients, locomotive syndrome stage improved significantly at 6 months and 1 year after surgery, with 35 patients (23.3%) improving by 1 year. Conversely, dysphagia prevalence increased over time and was significantly higher at 1 year; new-onset dysphagia occurred in 28 patients (18.7%). Changes in dysphagia status differed significantly between patients with and without improvement in locomotive syndrome stage, with greater deterioration observed in patients without improvement (p = 0.009). A multivariable logistic regression analysis demonstrated a significant association between improvement in dysphagia status and improvement in locomotive syndrome stage. Conclusions: In older patients with DCM, posterior subaxial cervical surgery was associated with modest improvement in locomotive syndrome stage but increased dysphagia risk. Persistent postoperative locomotive impairment may identify patients requiring careful swallowing assessment.