Outcomes of Lumbar Spinal Fusion in Patients Older than 75

2012

Background

As life expectancy increases, the unexplored question of whether surgery remains beneficial for octogenarians compared with those older than 65 is of increasing importance.

Purpose

This study compares the surgical outcomes and complications of patients >75 to those 65-75.

Study Design

Retrospective cohort analysis of prospectively collected data

Patient Sample

285 consecutive patients undergoing spinal fusion with age greater than 75

Outcome Measures

Visual-analog pain scale (VAS) and Oswestry Disability Index (ODI)

Methods

285 consecutive patients underwent spinal fusion with mean follow-up of 5.6 years. 91 patients age 75+ were compared with 194 patients age 65-75. Diagnoses were spondylolisthesis (n=117), scoliosis (n=83), kyphosis (n=16) and other degenerative spinal disorders (n=77). Number of levels fused was similar (4.5 vs 5.1). Outcomes were obtained prospectively by visual-analog pain scale (VAS) and Oswestry Disability Index (ODI) at pre-op and each follow up at 1-4 years.

Results

Patients >75 and 65-75 had similar and significant improvement at 1 year post-op for VAS (-3.1 vs-3.3) and ODI (-16.7 vs-20.9). For both groups, outcomes slightly worsened between 1 and 2 years and subsequently stabilized, but remained significantly improved compared with pre-op. There were no significant differences in outcome between the groups at any time. Complications between groups were similar and included non-union (5 [5.5%] vs 9 [4.6%]), adjacent level fracture (7 [7.7%] vs 12 [6.2%]), infection (5 [5.5%] vs 7 [3.6%]), foot drop (4 [4.4%] vs 3 [1.5%]), implant failure (0 [0.0%] vs 3 [1.5%]), spinal imbalance (5 [5.5%] vs 15 [7.7%]), arachnoiditis (2 [2.2%] vs 2 [1.0%]), cardiopulmonary failure (2 [2.2%] vs 1 [0.5%]), PE (0 [0.0%] vs 2 [1.0%]), CVA (0 [0.0%] vs 1 [0.5%]), and death (3 [3.3%] vs 5 [2.6%]). Revision rates were also similar (15 [16.5%] vs 43 [22.1%]).

Conclusion Spinal fusion in elderly patients result in clinical improvement that is greatest at 1 year post-op, but remains significant for at least 4 years. The outcome and complication rates between patients 75+ and 65-75 are similar, suggesting that patient age is not an independent factor in determining outcome of spinal fusions in those greater than 65.