Is surgery an appropriate treatment option for those over 80 years of age with acute spine diseases?

As the number of Americans aged 80 and older continues to increase, so does the percentage of patients with acute spinal conditions. A new study, appearing in the Feb. 4 issue of the Journal of Bone & Joint Surgery (JBJS), found that patients with lumbar spinal stenosis with and without degenerative spondylolisthesis benefit significantly from surgical treatment -- spinal conditions that cause leg and back pain, numbness and weakness. and no higher overall complication rate and higher death rate in patients 80 years of age and older compared to patients younger than 80

Between 2000 and 2010, the U.S. population aged 80 and over increased by 22 percent to 11.2 million, and about 47 percent of Americans age 60 and older have spinal stenosis, a narrowing of the spinal canal due to aging-related wear and tear.

In this study, researchers reviewed Spine Patient Outcomes Research Trial (SPORT) data for 105 patients aged 80 years and older and 1,130 patients younger than 80 years of age with either lumbar stenosis alone or with degenerative spondylolisthesis. Clinical characteristics of patients, such as age, gender, ethnicity, university and employment status, body mass index (BMI), smoking, comorbidities, level of back and leg pain, self-assessment of general health, and treatment preference were initially reviewed. Pain levels, general health assessment, complications, need for revision surgery, and mortality were measured postoperatively for up to four years.

Fifty-eight (55.2 percent) of patients who were at least 80 years old underwent surgery – either spinal fusion (arthrodesis) or a laminectomy, which is the removal of the bone spur, bone, and ligaments pressing on the spinal nerves. - as in 749 (66.3 percent) of patients under 80 years of age. At baseline, patients aged 80 years and older had a higher prevalence of hypertension, heart disease, osteoporosis and joint problems, but a lower BMI and a lower incidence of depression and smoking. Among other findings:

Averaged over a four-year follow-up, operatively treated patients at least 80 years of age had significantly greater improvement in all primary and secondary outcome measures than patients at least 80 years of age who received nonsurgical treatment.

Both groups—under 80 years of age and older—had similar complication rates during and after surgery, reoperations, and postoperative mortality.

The rate of multilevel lumbar laminectomy (those involving three or more levels of the spine) was significantly greater in patients 80 years of age and older compared to younger patients (60 percent versus 32 percent).

The benefits of surgery in patients at least 80 years of age were similar to those in younger patients, except for higher pain and physical function outcome measures in the under-80 age group.

Rothman Institute orthopedic surgeon Dr. and associate professor at Thomas Jefferson University Hospital, Philadelphia. “Patients in this age group had significant improvement in their post-operative function and complication rates comparable to the younger population. Based on the results of this study, surgery should be considered viable. The treatment option for these low back disorders in patients older than 80 years. Better cost-effectiveness of surgery in this patient population. Future studies are needed to evaluate

Study Details

Analysis of patients treated for lumbar stenosis and degenerative spondylolisthesis participating in the Spine Patient Outcomes Research Trial (SPORT) was performed. Patients who were at least 80 years old were compared with those under 80 years old. Baseline patient and clinical characteristics were noted, and the difference in improvement from baseline between operative and non-operative treatment was determined for each group at each follow-up period. up to four years. A random individual effect was included to account for correlation between repeated measures within individuals, and a formal duration of interaction between treatment and age was included to compare treatment effect in subgroups.