Surgical Risk Assessment and Prevention in Elderly Spinal Deformity Patients

Abstract

Introduction: Prevalence of adult deformity surgery in the elderly individuals continues to increase. These patients have additional considerations for the spine surgeon during surgical planning. We perform an informative review of the spinal and geriatric literature to assess preoperative and intraoperative factors that impact surgical complication occurrences in this population. Significance: There is a need to understand surgical risk assessment and prevention in geriatric patients who undergo thoracolumbar adult deformity surgery in order to prevent complications. Methods: Searches of relevant biomedical databases were conducted by a medical librarian. Databases searched included MEDLINE, Web of Science, CINAHL, IPA, Cochrane, PQ Health and Medical, SocINDEX, and WHO’s Global Health Library. Search strategies utilized Medical Subject Headings plus text words for extensive coverage of scoliosis and surgical technique concepts. Results: Degenerative scoliosis affects 68% of the geriatric population, and the rate of surgical interventions for this pathology continues to increase. Complications following spinal deformity surgery in this patient population range from 37% to 62%. Factors that impact outcomes include age, comorbidities, blood loss, and bone quality. Using these data, we summarize multimodal risk prevention strategies that can be easily implemented by spine surgeons. Conclusions: After evaluation of the latest literature on the complications associated with adult deformity surgery in geriatric patients, comprehensive perioperative management is necessary for improved outcomes. Preoperative strategies include assessing physiological age via frailty score, nutritional status, bone quality, dementia/delirium risk, and social activity support. Intraoperative strategies include methods to reduce blood loss and procedural time. Postoperatively, development of a multidisciplinary team approach that encourages early ambulation, decreases opiate use, and ensures supportive discharge planning is imperative for better outcomes for this patient population.

Spinal Cord Stimulation: A Reasonable Alternative Treatment in Patients With Symptomatic Adult Scoliosis for Whom Surgical Therapy Is Not Suitable? A Pilot Study

“…Furthermore, it should be underscored that the results of our study apply to an elderly cohort with a median age of 78 and BMI of 29 kg/m 2 (overweight), both of which are considered risk factors for perioperative morbidity (29,30). As such, performing corrective spondylodesis in these patients may have not resulted in satisfactory results and the response to SCS as found in this cohort may be considered a reasonable alternative.…”

Prophylactic Use of Antibiotics for Fever After Drainage Removal Following a Dural Tear During Lumbar Spinal Surgery: A Retrospective Study

“…With the increase of age, the incidence of dural tear gradually increased in the present study. A significantly higher dural tear rate was found in patients older than 60 years ( P <0.05), mainly because patients’ diseases get worse with the increase of age, and the comorbidities associated with aging increased the difficulty of surgeries [ 29 ]. Furthermore, more revision surgeries occurred among the older patients.…”

A Self-Contained 3D Biomechanical Analysis Lab for Complete Automatic Spine and Full Skeleton Assessment of Posture, Gait and Run

“…Such a descending-path approach, i.e., correcting the upper part and evaluating the outcomes down to the lower limbs, disregards possible active influences on the spine deriving from lower-limbs posture corrections, possibly in a conservative rehabilitation approach. Worth noting, the surgical approach is hazardous for older patients, with a high rate of postoperative complications (37% to 62%), requiring lengthy recovery times along with being very expensive [ 109 ]. Furthermore, the success rate is relatively low.…”