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

Abstract

Purpose Degenerative spondylolisthesis (DS) is a debilitating condition that carries a high economic burden. As the global population ages, the number of patients over 80 years old demanding spinal fusion is constantly rising. Therefore, neurosurgeons often face the important decision as to whether to perform surgery or not in this age group, commonly perceived at high risk for complications. Methods Six hundred seventy-eight elder patients, who underwent posterolateral lumbar fusion for DS (performed in three different centers) from 2012 to 2020, were screened for medical, early and late surgical complications and for the presence of potential preoperative risk factors. Patients were divided in three categories based on their age: (1) 60–69 years, (2) 70–79 years, (3) 80 and over. Multiple logistic regression was used to determine the predictive power of age and of other risk factors (i.e., ASA score; BMI; sex; presence or absence of insulin-dependent and -independent diabetes, use of anticoagulants, use of antiaggregants and osteoporosis) for the development of postoperative complications. Results In univariate analysis, age was significantly and positively correlated with medical complications. However, when controls for other risk factors were added in the regressions, age never reached significance, with the only noticeable exception of cerebrovascular accidents. ASA score and BMI were the two risk factors that significantly correlated with the higher numbers of complication rates (especially medical). Conclusion Patients of different age but with comparable preoperative risk factors share similar postoperative morbidity rates. When considering octogenarians for lumbar arthrodesis, the importance of biological age overrides that of chronological.

Are Octogenarians at Higher Risk of Complications After Elective Lumbar Spinal Fusion Surgery? Analysis of a Cohort of 7,880 patients from the Kaiser Permanente Spine Registry

“…Our study highlights the importance of perioperative optimization and close surveillance of older patients to mitigate complications. We fully agree with Aimar et al 22 that "biological age overrides that of chronological. "…”

“…Reviewing the literature (Table 4), we identified four similar studies to ours—lumbar spine fusions, with a comparison of patients 80 years old and above to younger patients with long follow-up periods 8,10,21,22. Rihn et al ,10 using data from the Spine Patient Outcomes Research Trial, found no significant difference in risk of complications and mortality in patients 80 years old and above compared with younger patients for operative treatment of lumbar stenosis and degenerative spondylolisthesis.…”

“…Reviewing the literature (Table 4), we identified four similar studies to ours-lumbar spine fusions, with a comparison of patients 80 years old and above to younger patients with long follow-up periods. 8,10,21,22 Rihn et al, 10 using data from the Spine Patient Outcomes Research Trial, found no significant difference in risk of complications and mortality in patients 80 years old and above compared with younger patients for operative treatment of lumbar stenosis and degenerative spondylolisthesis. More recently, Aimar et al 22 studied 678 patients (179 patients, 80 yr and above) who underwent posterolateral lumbar fusions (one or two levels, no scoliosis > 5°) and found rates of postoperative complications did not increase with increasing age.…”

“…8,10,21,22 Rihn et al, 10 using data from the Spine Patient Outcomes Research Trial, found no significant difference in risk of complications and mortality in patients 80 years old and above compared with younger patients for operative treatment of lumbar stenosis and degenerative spondylolisthesis. More recently, Aimar et al 22 studied 678 patients (179 patients, 80 yr and above) who underwent posterolateral lumbar fusions (one or two levels, no scoliosis > 5°) and found rates of postoperative complications did not increase with increasing age. In contrast, Marbacher et al 8 in their study of three age groups [younger (50-64 yr; n = 317), older ( ≥ 65 yr < 80 yr: n = 350), and geriatric (80 yr and above: n = 40)], from prospectively collected data nested within the Eurospine Spine Tango System, higher comorbidity and complication rates in the geriatric patients.…”

Articular arthrodesis with the facet wedge technique for the treatment of unstable lumbar degenerative disease and associated conditions: A retrospective study of 96 patients

“…Unlike other reports found in the literature on LIF and posterolateral fusion, which identified significant associations between certain preoperative risk factors such as higher BMI and older age with worse clinical outcomes, none of the preoperative variables (Age, ASA, BMI, gender, and surgical indication) appeared to be significant predictors. 15 , 16 , 17 However, it is noteworthy that ASA approached significance.…”