Complications and Outcomes of Lumbar Spine Surgery in Elderly People: A Review of the Literature

Cloyd, Jordan M.; Acosta, Frank L.; Ames, Christopher P.

doi:10.1111/j.1532-5415.2008.01771.x

Cited by 123 publications

(87 citation statements)

References 59 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…While the majority of these adverse events were relatively minor and easily managed, such as incidental durotomies and superficial infections, several patients required a return to the operating room to manage infection or for drainage of fluid collections, with one patient dying from pneumonia contracted in the recovery period. While this incidence of complications in our sample was consistent with that reported in the literature [5], this serves as a reminder that lumbar surgery in even relatively healthy older adults is not without risk. We plan to pursue a larger, appropriately powered longitudinal study (guided by the results of this pilot project), in which we explore which baseline characteristics predict intra-and postoperative complications, and if complications of varying type and severity affect functioning and satisfaction outcomes.…”

Section: Discussionsupporting

confidence: 92%

See 1 more Smart Citation

Clinical and Neuropsychiatric Correlates of Lumbar Spinal Surgery in Older Adults: Results of a Pilot Study

et al. 2016

View full text Add to dashboard Cite

Aim:To improve selection of older lumbar surgical candidates, we surveyed correlates of functioning and satisfaction with surgery. Materials & methods: Prospective sample at lumbar spine surgery clinic. Patients (n = 48) were evaluated before surgery and after 3 months. Dependent variables were functioning and surgical satisfaction. Results: Baseline variables associated with disability at 3 months included cognitive status and widespread pain. There was clinically significant improvement with moderate effects sizes for anxiety and depression at follow-up. Patients with at least a 30% improvement in disability had better physical health-related quality of life and were less likely to report widespread pain before surgery. Conclusion: Although preliminary, two novel potential predictors of lumbar surgery outcome include diminished cognitive functioning and widespread pain. Further study of these variables on post-surgical functioning and satisfaction may improve patient selection. Summary points• In late life, low back pain with and without leg pain is frequently associated with functional disability, psychosocial impairment, poor sleep quality and depression.• A substantial body of literature has identified comorbidities that predict suboptimal spine surgery outcome, including musculoskeletal conditions, impaired gait, cardiovascular disease, and mood and anxiety disorders.• We observed that mild cognitive impairment and the presence of widespread pain may be two potential predictors of satisfaction and disability following lumbar surgery. Given the relatively high frequency at which these two conditions occur in older adults in clinical settings, future projects are warranted to understand their potential impact on surgical outcome, functioning and satisfaction.• Patients with at least a 30% improvement in disability had better physical health-related quality of life and were less likely to report widespread pain before surgery.• Depression and anxiety both improved at the 3-month follow-up with moderate effect sizes for both.For reprint orders, please contact: reprints@futuremedicine.com

show abstract

Section: Discussionsupporting

confidence: 92%

“…Published failure rates range from 30 to 46% for vertebral fusion, 19-25% for microdiscectomy and approximately 35% for lumbar decompressive surgery [4]. Additionally, complications are common in older adults undergoing lumbar spine surgery, with incidences ranging from 6.9 to 35.2% for decompression and 37-80% for fusion [5].…”

Section: Future Science Groupmentioning

confidence: 99%

Clinical and Neuropsychiatric Correlates of Lumbar Spinal Surgery in Older Adults: Results of a Pilot Study

et al. 2016

View full text Add to dashboard Cite

show abstract

“…1A), and long-segment fusions are associated with complication rates ranging from 10% to 75%. 4,8,10,11,15,19,23,25,30,31,33 Minimally invasive surgery (MIS) for ASD correction has become increasingly popular. As reported by Smith et al, outcome measures after ASD surgery in elderly patients improve more dramatically than in younger patients, and with an increasing elderly population, minimally invasive surgical correction will remain an important option.…”

mentioning

confidence: 99%

Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques

Uribe

Deukmedjian

Mummaneni³

et al. 2014

FOC

134

View full text Add to dashboard Cite

Object It is hypothesized that minimally invasive surgical techniques lead to fewer complications than open surgery for adult spinal deformity (ASD). The goal of this study was to analyze matched patient cohorts in an attempt to isolate the impact of approach on adverse events. Methods Two multicenter databases queried for patients with ASD treated via surgery and at least 1 year of follow-up revealed 280 patients who had undergone minimally invasive surgery (MIS) or a hybrid procedure (HYB; n = 85) or open surgery (OPEN; n = 195). These patients were divided into 3 separate groups based on the approach performed and were propensity matched for age, preoperative sagittal vertebral axis (SVA), number of levels fused posteriorly, and lumbar coronal Cobb angle (CCA) in an attempt to neutralize these patient variables and to make conclusions based on approach only. Inclusion criteria for both databases were similar, and inclusion criteria specific to this study consisted of an age > 45 years, CCA > 20°, 3 or more levels of fusion, and minimum of 1 year of follow-up. Patients in the OPEN group with a thoracic CCA > 75° were excluded to further ensure a more homogeneous patient population. Results In all, 60 matched patients were available for analysis (MIS = 20, HYB = 20, OPEN = 20). Blood loss was less in the MIS group than in the HYB and OPEN groups, but a significant difference was only found between the MIS and the OPEN group (669 vs 2322 ml, p = 0.001). The MIS and HYB groups had more fused interbody levels (4.5 and 4.1, respectively) than the OPEN group (1.6, p < 0.001). The OPEN group had less operative time than either the MIS or HYB group, but it was only statistically different from the HYB group (367 vs 665 minutes, p < 0.001). There was no significant difference in the duration of hospital stay among the groups. In patients with complete data, the overall complication rate was 45.5% (25 of 55). There was no significant difference in the total complication rate among the MIS, HYB, and OPEN groups (30%, 47%, and 63%, respectively; p = 0.147). No intraoperative complications were reported for the MIS group, 5.3% for the HYB group, and 25% for the OPEN group (p < 0.03). At least one postoperative complication occurred in 30%, 47%, and 50% (p = 0.40) of the MIS, HYB, and OPEN groups, respectively. One major complication occurred in 30%, 47%, and 63% (p = 0.147) of the MIS, HYB, and OPEN groups, respectively. All patients had significant improvement in both the Oswestry Disability Index (ODI) and visual analog scale scores after surgery (p < 0.001), although the MIS group did not have significant improvement in leg pain. The occurrence of complications had no impact on the ODI. Conclusions Results in this study suggest that the surgical approach may impact complications. The MIS group had significantly fewer intraoperative complications than did either the HYB or OPEN groups. If the goals of ASD surgery can be achieved, consideration should be given to less invasive techniques.

show abstract

“…Quoted complication rates in older patients after surgical treatment of LSS range between 2.5 and 80% [5,24]. Generally, minor complications that do not prolong hospital stay make up the largest part [6,7,18,19,21,22].…”

Section: Discussionmentioning

confidence: 99%

“…But interestingly patients of group 3 underwent rigid stabilization and/or fusion less frequently than patients from group 1 (p = 0.003) or group 2 (p = 0.013) ( Table 1), giving rise to the suspicion that complications after rigid stabilization and/or fusion in aged people were feared. The question whether fusion or stabilization accompanying decompression increases the rate of complications in older versus younger patients was already discussed in the literature [5]. Kilincer et al compared complication rates in younger (\65 years) and older ([65 years) patients (n = 129) after posterior decompression (100%) with stabilization (94%) or fusion (6%).…”

Section: Discussionmentioning

confidence: 99%

Predictors of surgical, general and follow-up complications in lumbar spinal stenosis relative to patient age as emerged from the Spine Tango Registry

et al. 2011

View full text Add to dashboard Cite

Introduction Published opinions regarding the outcomes and complications in older patients have a broad spectrum and there is a disagreement whether surgery in older patients entails a higher risk. Therefore this study examines the risk of surgery for lumbar spinal stenosis relative to age in the pooled data set of the Spine Tango registry. Materials and methods Between May 2005 and February 2010 the database query resulted in 1,764 patients. The patients were subdivided into three socio-economically relevant age groups: \65 years, 65-74 years, C75 years. Frequencies for occurred surgical, general and follow-up complications were assessed. Multivariate and univariate logistic regressions were performed to reveal predictors for respective complication types. Results and discussion Our study found that age, ASA status and blood loss were significant co-varieties for the occurrence of general complications. The risk of general complications is increased in older versus younger patients. Fusion or rigid stabilization does not lead to more complications. Surgical complications as well as complication rates at follow-up showed no significant age-related variation. Physician-based outcome was good or excellent in over 80% of patients in all age groups.

show abstract

Complications and Outcomes of Lumbar Spine Surgery in Elderly People: A Review of the Literature

Cited by 123 publications

References 59 publications

Clinical and Neuropsychiatric Correlates of Lumbar Spinal Surgery in Older Adults: Results of a Pilot Study

Clinical and Neuropsychiatric Correlates of Lumbar Spinal Surgery in Older Adults: Results of a Pilot Study

Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques

Predictors of surgical, general and follow-up complications in lumbar spinal stenosis relative to patient age as emerged from the Spine Tango Registry

Contact Info

Product

Resources

About