Patient-rated Outcomes of Lumbar Fusion in Patients with Degenerative Disease of the Lumbar Spine: Does Age Matter?

Abstract

STUDY DESIGN: Single centre retrospective study of prospectively collected data, nested within the Eurospine Spine Tango data acquisition system. OBJECTIVE: The aim of this study was to assess the patient-rated outcome and complication rates associated with lumbar fusion procedures in three different age groups. SUMMARY OF BACKGROUND DATA: There is a general reluctance to consider spinal fusion procedures in elderly patients due to the increased likelihood of complications. METHODS: Before and at 3, 12, and 24 months after surgery, patients completed the multidimensional Core Outcome Measures Index (COMI). At the 3-, 12-, and 24-month follow-ups they also rated the Global Treatment Outcome (GTO) and their satisfaction with care. Patients were divided into three age groups: younger (50y < 65y; n = 317), older (65y < 80y; n = 350), and geriatric ( 80y; n = 40). RESULTS: 707 consecutive patients were included. The preoperative comorbidity status differed significantly (p < 0.0001) between the age groups, with the highest scores in the geriatric group. Medical complications during surgery were lower in the younger age group (7%) than in the older (13.4%; p = 0.006) and geriatric groups (17.5%; p = 0.007); surgical complications tended to be higher in the elderly group (younger, 6.3%; older, 6.0%; geriatric, 15.0%; p = 0.09). There were no significant group differences (p > 0.05) for the scores on any of the COMI domains, GTO, or patient-rated satisfaction at either 3-, 12-, and 24-months follow-up. CONCLUSIONS: Despite greater comorbidity and complication rates in geriatric patients, the patient-rated outcome was as good in the elderly as it was in younger age groups up to two years after surgery. These data indicate that geriatric age needs careful consideration of associated risks but is not per se a contraindication for fusion for lumbar degenerative disease. LEVEL OF EVIDENCE: 4.

Complications of degenerative lumbar spondylolisthesis and stenosis surgery in patients over 80 s: comparative study with over 60 s and 70 s. Experience with 678 cases

“…Nonetheless, few authors have analyzed complication rates of spinal surgery in general (i.e., not exclusively restricted to arthrodesis) in patients over 80, and those who did, not only have reported conflicting results but also with small sample sizes; however, spinal fusion is a more invasive surgery with respect to decompression and microdiscectomy, and in line with what other investigators have reported so far, our statistical analysis indicated that octogenarians had significantly higher rates of complications compared to individuals in their seventies or sixties for both medical and surgical complications [3,17,22,26].…”

“…In surgical procedures, postoperative morbidity and mortality is historically believed to increase progressively with growing age [6,17,21,31]. Yet, this correlation does not apply uniformly for all types of surgery, and some pose the elderly at higher risk for complications than others [10].…”

Thirty- and 90-day Readmissions After Spinal Surgery for Spine Metastases

“…18,19 Baseline functional limitations and lower levels of social and financial support further exacerbate postoperative outcomes. 18,19 Intriguingly, some studies have found no difference in complication rates, 20 extended LOS, 21 or reoperation rates 21 for octogenarians compared to younger patients following spine surgery, throwing into question the idea that older patients inherently will have worse surgical outcomes. For our study, it is possible that only particularly healthy elderly patients with an extended life expectancy were deemed fit enough to undergo surgical intervention and thus had lower readmission rates.…”

Evaluating Screw Stability After Pedicle Screw Fixation With PEEK Rods

“…With population aging, the number of patients with degenerative lumbar disease, such as lumbar spinal stenosis, lumbar instability and lumbar disc herniation, has increased each year, severely affecting people's quality of life. 1,2 For cases that do not respond to conservative treatment, surgical treatment is often required. Pedicle screw fixation is considered the gold standard surgical treatment for lumbar degeneration.…”