Surgery for Lumbar Spinal Stenosis in Individuals Aged 80 and Older: A Multicenter Observational Study

Giannadakis, Charalampis; Solheim, Ole; Jakola, Asgeir Store; Nordseth, Trond; Gulati, Agnete Malm; Nerland, Ulf S.; Nygaard, Øystein P.; Gulati, Sasha

doi:10.1111/jgs.14311

Cited by 35 publications

(26 citation statements)

References 45 publications

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“…A previous study on a similar population from the NORspine registry showed no difference in outcomes between non-responders and responders [21]. The minor differences in baseline characteristics between non-responders and responders at 1 year are not likely to influence our results [7,[13][14][15]. Also, we are lacking data on exact amounts of costs, payment, and reimbursements, inhibiting us from performing cost-effectiveness analyses.…”

Section: Study Strengths and Limitationsmentioning

confidence: 77%

Surgery for herniated lumbar disc in private vs public hospitals: A pragmatic comparative effectiveness study

et al. 2020

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Background There is limited evidence on the comparative performance of private and public healthcare. Our aim was to compare outcomes following surgery for lumbar disc herniation (LDH) in private versus public hospitals. Methods Data were obtained from the Norwegian registry for spine surgery. Primary outcome was change in Oswestry disability index (ODI) 1 year after surgery. Secondary endpoints were quality of life (EuroQol EQ-5D), back and leg pain, complications, and duration of surgery and hospital stays. Results Among 5221 patients, 1728 in the private group and 3493 in the public group, 3624 (69.4%) completed 1-year followup. In the private group, mean improvement in ODI was 28.8 points vs 32.3 points in the public group (mean difference − 3.5, 95% CI − 5.0 to − 1.9; P for equivalence < 0.001). Equivalence was confirmed in a propensity-matched cohort and following mixed linear model analyses. There were differences in mean change between the groups for EQ-5D (mean difference − 0.05, 95% CI − 0.08 to − 0.02; P = 0.002) and back pain (mean difference − 0.2, 95% CI − 0.2, − 0.4 to − 0.004; P = 0.046), but after propensity matching, the groups did not differ. No difference was found between the two groups for leg pain. Complication rates was lower in the private group (4.5% vs 7.2%; P < 0.001), but after propensity matching, there was no difference. Patients operated in private clinics had shorter duration of surgery (48.4 vs 61.8 min) and hospital stay (0.7 vs 2.2 days). Conclusion At 1 year, the effectiveness of surgery for LDH was equivalent in private and public hospitals.

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Section: Study Strengths and Limitationsmentioning

confidence: 77%

Surgery for herniated lumbar disc in private vs public hospitals: A pragmatic comparative effectiveness study

et al. 2020

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“…LSS is more common in the geriatric population and in many studies the mean age of the sample size is more than 65 years. Recent studies which have compared traditional surgery to BDUA for patients aged 80 years and older have demonstrated that there were no between-group differences in duration and outcome results of the surgical procedures (9). In the current study, unlike previous studies, patients were separated according to age as an elderly group (>60 years) and an adult group (<60 years).…”

Section: Limitationsmentioning

confidence: 88%

The effects of microdecompression on quality of life in patients who have lumbar degenerative spinal stenosis with or without degenerative spondylolisthesis

Öğden

Yüksel²,

Bakar³

et al. 2018

Turkish Neurosurgery

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ligamentum flavum hypertrophy and central degenerative disc herniation. This is a clinical and radiological condition seen in more than 65% of females and 80% of males, with incidence directly related to age. In addition, degenerative spondylolisthesis, basically a facet joint lesion, develops as a consequence of degeneration of the lumbar vertebrae, resulting in hypertrophy and segmental instability in the facet joints. With age, the inferior and superior articular processes of the AIM: To investigate the mid-term efficacy of bilateral decompression with a unilateral approach (BDUA) on symptoms and quality of life of in patients with lumbar spinal stenosis (LSS), with low grade (with percentage slip <25%) degenerative spondylolisthesis or without spondylolisthesis. MATERIAL and METHODS:The study included patients who underwent BDUA due to one or two-level LSS related to degenerative spondylosis and/ or degenerative spondylolisthesis. Pre-and postoperative data of the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and walking distance were compared. RESULTS:Evaluation was made up of a total of 53 patients, comprising 32 males and 21 females with a mean age of 60.6 ± 9.0 years. Compared with the preoperative data, VAS, ODI and walking distance improved significantly in all patients at the 3-year follow-up examination. Furthermore, a significant improvement was determined in the clinical parameters of patients with degenerative spondylolisthesis, with no worsening of slip and no requirement for instrumentation. Moreover, when patients were separated into two groups according to age, as elderly (>60 years) and adult (<60 years), similar improvements were seen in both groups.CONCLUSION: BDUA could be quite effective in reducing pain, improving quality of life and walking distance with no worsening of the grade or degree of slipping.

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“…In the study by Rihn et al, 10 only 8.6% (n = 5) of the octogenarians underwent instrumented fusion, hence limiting further subgroup analysis for a fusion-only cohort. The clinical success of lumbar decompression surgery in the octogenarian population has been further established in studies by Giannadakis et al, 11 Galiano et al, 12 and Shabat et al 13 However, it is important to note that these studies address lumbar decompression, but do not address the viability of fusion, which highlights the need to better understand the role of lumbar fusion in the octogenarian population from both a clinical and operative standpoint.…”

Section: Discussionmentioning

confidence: 99%

“…2–5 Several studies have demonstrated an increase in lumbar surgical intervention (decompression and/or fusion) in the broadly termed elderly population over the past 20 years. 2,3,6–8 Other studies have investigated safety and efficacy of lumbar spine surgery in this age group, with results showing both benefits 9–13 and risks. 14 However, no prior study has specifically identified national trends in the use of lumbar fusion surgery for the octogenarian population, with respect to demographics, discharge time, and economic impact.…”

Section: Introductionmentioning

confidence: 99%

Trends in Lumbar Fusion Surgery Among Octogenarians: A Nationwide Inpatient Sample Study From 2004 to 2013

Kha

Ilyas

Tanenbaum

et al. 2018

Global Spine Journal

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Study Design:Retrospective analysis.Objectives:Given the aging US population and natural degenerative process of the spine, more elderly patients with lumbar spinal disease are surgical candidates. Prior studies have assessed safety and efficacy of lumbar fusion (LF) surgeries in the elderly, but none have reviewed fusion procedures from an epidemiological standpoint. Here, we report 2004-2013 national trends in demographics, discharge time, and economic impact of LF procedures for octogenarians.Methods:The Nationwide Inpatient Sample database was queried from 2004 to 2013 for LF procedures in patients aged 80 to 89 years. Patients were grouped by fusion level, demographics, comorbidity score, insurance, and hospital characteristics. Postoperative variables include length of stay and total in-hospital charges. Data was evaluated using chi-squared tests and t tests.Results:The national sample included 17 471 LF procedures (mean age = 82.65 years). From 2004 to 2013, the annual number of LF procedures increased from 1144 to 2061 patients. Percentage of multilevel LF was relatively maintained (mean = 18%). The majority of patients were female (mean = 62%). The proportion of males increased during the study period (31.8% to 42.5%; P < .0001). The proportion of patients with a comorbidity score of 2 or 3 increased during the study period (P < .0001). Over time, average length of stay decreased (from 6 to 4.5 days; P < .0001), and total in-hospital charges increased (from $58 471 to $111 235; P < .0001).Conclusions:These results suggest that more lumbar fusion procedures are being performed on octogenarians in recent years. While these patients are discharged from hospitals more quickly after surgery, there is also greater financial burden placed on patients, hospitals, and society.

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Surgery for Lumbar Spinal Stenosis in Individuals Aged 80 and Older: A Multicenter Observational Study

Abstract: Individuals aged 80 and older experience improvement in self-reported outcomes similar to those of younger individuals after decompressive surgery for LSS.

Cited by 35 publications

References 45 publications

Surgery for herniated lumbar disc in private vs public hospitals: A pragmatic comparative effectiveness study

Surgery for herniated lumbar disc in private vs public hospitals: A pragmatic comparative effectiveness study

The effects of microdecompression on quality of life in patients who have lumbar degenerative spinal stenosis with or without degenerative spondylolisthesis

Trends in Lumbar Fusion Surgery Among Octogenarians: A Nationwide Inpatient Sample Study From 2004 to 2013

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