Original ArticleIs Eighty the New Sixty? Outcomes and Complications after Lumbar Decompression Surgery in Elderly Patients over 80 Years of Age
Introduction
As the population in westernized countries ages, the incidence of octogenarian and nonagenarians with degenerative spine diseases is rising. Approximately 47% of individuals older than 60 years will experience lumbar spinal canal stenosis.1
The number of surgical procedures for lumbar degenerative spine disease performed in older patients, particularly decompressive spine surgery, has increased substantially over the last decade.2 Treatment guidelines for older patients with degenerative spine disease, however, are still rare. Long-term data for several studies show a benefit of surgical treatment of lumbar stenosis compared with conservative treatment,3, 4, 5 but do not specifically focus on the effects of age on clinical outcome. As relevant comorbidities occur more often in octogenarians than in a younger population, perioperative complication and mortality rates might be higher for these patients.6 The results for the octogenarian population in the Spine Patient Outcomes Research trial revealed that surgical treatment of lumbar spinal stenosis (LSS) with or without degenerative spondylolisthesis offers a benefit over nonsurgical treatment. The complication rate in this cohort was similar compared with patients younger than 80 years.7 As the indication for surgery is often not absolute but relative, comorbidities and other preoperative risk factors must be considered when deciding for or against surgery in these mostly moribund patients. The aim of the present study was to assess the clinical outcome and perioperative complications for surgical decompression in degenerative lumbar spinal disease in octogenarian and nonagenarian patients.
Section snippets
Patients and Methods
This retrospective single-center cohort study was approved by the local medical ethics committee (245/16S) and is in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments.8
Surgery
Mean duration of surgery was 89.7 ± 34.7 minutes (range, 13–201 minutes). Surgery was performed for LSS (184 patients; 75.4%), LDH (13 patients; 5.3%), or a combination of both (47 patients; 19.3%). Most patients received 1- or 2-level decompression surgery (1-level, 31.1%; 2-level, 45.5%; 3-level, 21.7%; 4-level, 1.7%). Fifty-three patients (21.7%) had at least one previous lumbar spine surgery involving the index level (Table 1).
Neurologic Deficits and Pain
Seventy-six (31.3%) patients experienced preoperative neurologic
Discussion
Surgical treatment of patients older than 80 years can be challenging, as the majority of these patients have relevant medical disorders necessitating regular medication, anticoagulants included. Data from previous studies could show a benefit of surgery for older patients with degenerative diseases of the lumbar spine7 and address the effectiveness of surgical treatment.10, 11 The present study examined one of the largest monocentric octogenarian and nonagenarian population with LSS and LDH
Conclusion
Despite advanced age, the vast majority of octogenarians and nonagenarians benefited from lumbar decompression surgery. Surgery-related complications occurred relatively frequently, but most them were mild to moderate, whereas the majority of the few perioperative medical complications was severe. Nevertheless, the rate of medical complications was acceptable. We had no serious surgical complications and no permanent new postoperative neurologic deficits in the assessed patient series. With
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Cited by (37)
Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of lumbar spinal stenosis, 2021 - Secondary publication
2023, Journal of Orthopaedic ScienceCitation Excerpt :Even in the octagenarian and over, surgery (mainly decompression) for LSS resulted in good clinical outcomes and is considered a useful treatment method. However, it should be performed with caution for perioperative and postoperative complications [295,301,303–306,308–314]. As symptoms that are difficult to improve after surgical treatment greatly affect patient satisfaction, it is important to obtain informed consent of those following a general explanation before surgery.
Lumbar spine surgery in the elderly patient
2020, Seminars in Spine SurgeryCitation Excerpt :Likewise, lower baseline functional status and decreased BMI among geriatric patients has also been linked to increased complication and readmission rates following lumbar surgery, with the former also associated with a higher risk of developing postoperative delirium.11,12 Despite this, less invasive procedures, like decompression alone, have shown acceptable rates of postoperative medical complications.13 While advanced ago may increase the risk of medical complications following lumbar surgery, there is conflicting literature as to the effect it has on surgical complications.
The joint management of Geriatrics-Neurosurgery of patients older than 75 years reduces the average stay, morbidity, hospital readmissions and mortality per year
2020, Revista Espanola de Geriatria y Gerontologia
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Bernhard Meyer and Yu-Mi Ryang are co-senior authors who contributed equally to this work.