Surgical management of lumbar spinal stenosis in patients over 80: is there an increased risk?

Abstract

Management of lumbar spinal stenosis (LSS) represents the rst cause of spinal surgery for the elderly and will increase with the aging population. Although the surgery improves quality of life, the procedure involves anaesthetic and operative risks. The aim of this study was to assess whether the postoperative complications rate was higher for elderly patients and to nd confounding factors. Material and MethodsWe conducted a retrospective study including all LSS surgeries between 2012 and 2020 at the University Hospital of Caen. We compared two populations opposing patients aged over 80 with others. The primary endpoint was the occurrence of a severe complication (SC). Minor complications were the secondary endpoint. Comorbidities, history of lumbar spine surgery and surgical characteristics were recorded. Results996 patients undergoing surgery for degenerative LSS were identi ed. Patients over 80 were signi cantly affected by additional comorbidities: hypertension, heart diseases, higher age-adjusted comorbidity Charlson score, ASA score and use of anticoagulants. Knee-chest position was preferred for younger patients. Older patients underwent a more extensive decompression and had more incidental durotomies. 5.2% of patients presented SC. Age over 80 did not appear to be a signi cant risk factor for SC, but minor complications increased. Multivariate analysis showed that heart diseases, history of laminectomy, AA-CCI, and accidental durotomies were independent risk factors for SC. ConclusionSurgical management for lumbar spinal stenosis is not associated to a higher rate of severe complications for patients over 80 years of age.However, preoperative risk factors should be investigated to warn the elderly patients that the complications risk is increased although an optimal preparation is the way to avoid them.

One- and 2-year outcomes of lumbar facet arthroplasty versus spinal fusion in young (<65 years) and old (≥65 years) patients for the treatment of degenerative spondylolisthesis and stenosis

“…Spinal surgery for lumbar stenosis and spondylolisthesis is increasingly performed, particularly in the elderly population. As age increases, patients undergoing spinal surgery are more likely to have greater comorbidities and a more fragile physical condition [ 27 , 28 ]. A meta-analysis of surgical outcomes for lumbar stenosis and spondylolisthesis comparing young (<80) versus old (≥80) found significantly greater postoperative complications, including mortality and reoperation, occurred in the elderly for both decompression-only and decompression with fusion [ 27 ].…”

“…A meta-analysis of surgical outcomes for lumbar stenosis and spondylolisthesis comparing young (<80) versus old (≥80) found significantly greater postoperative complications, including mortality and reoperation, occurred in the elderly for both decompression-only and decompression with fusion [ 27 ]. However, the association of age and complications is not fully elucidated with some studies only finding differences in minor complications [ 28 , 29 ] and others finding no significant differences [ 30 ]. Additionally, it is worth noting that older patients may require more extensive surgery [ 30 ], and the presence of comorbidities is a risk factor for complications and mortality independent of age [ 28 , 31 ].…”

“…However, the association of age and complications is not fully elucidated with some studies only finding differences in minor complications [ 28 , 29 ] and others finding no significant differences [ 30 ]. Additionally, it is worth noting that older patients may require more extensive surgery [ 30 ], and the presence of comorbidities is a risk factor for complications and mortality independent of age [ 28 , 31 ]. Despite the potentially greater risk of surgery, patient reported outcomes in older adults do not significantly differ from their younger counterparts in showing a difference from baseline or compared to a non-surgical treatment group [ [27] , [28] , [29] , [30] , 32 ].…”