Age and Lumbar Surgery

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Object. Although advances in patient care have enabled surgeons to perform posterior lumbar decompression and fusion (PLDF), increased age remains a major concern when designing a treatment strategy. The authors conducted a study to evaluate if increased age has any effect on lumbar fusion surgery in terms of perioperative events.

Methods. This retrospective study comprised 129 patients (age range 25–91 years) with spondylolisthesis, lumbar stenosis and/or disc degeneration/herniation with instability, or unsuccessful results after a failed previous PLDF. The patients were stratified by age: those younger than 65 years of age (85 patients) and those at least 65 years of age (44 patients). The parameters reviewed included comorbid conditions, American Society of Anesthesiologists score, instrumentation technique (pedicle screws, a combination of pedicle screw fixation [PSF] and posterior lumbar interbody fusion [PLIF], or noninstrumented fusions), number of fused levels, operative time, estimated blood loss (EBL), complications, and hospital length of stay (LOS).

Fusion strategies in the elderly tended to be more conservative. Repeated operations and PSF/PLIF procedures were less frequent in the older age group. Older age did not result in increased complications, EBL, and operative time. Longer hospital LOS was observed in the older age group (7 ± 3.5 days) compared with the younger age group (5.5 ± 1.9 days) (p = 0.022).

Conclusions. Complications and perioperative events following PLDF in the elderly are comparable with those observed in younger patients. Withholding lumbar spine fusion solely based on advanced age is not warranted.

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© AANS, except where prohibited by US copyright law.

References

  • 1.

    Resnick DKChoudhri TFDailey ATGroff MWKhoo LMatz PGet al. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 9: fusion in patients with stenosis and spondylolisthesis. J Neurosurg Spine 2:6796852005Resnick DK Choudhri TF Dailey AT Groff MW Khoo L Matz PG et al. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 9: fusion in patients with stenosis and spondylolisthesis. J Neurosurg Spine 2:679–685 2005

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  • 2.

    Resnick DKChoudhri TFDailey ATGroff MWKhoo LMatz PGet al.; Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 12: pedicle screw fixation as an adjunct to posterolateral fusion for low-back pain. J Neurosurg Spine 2:7007062005Resnick DK Choudhri TF Dailey AT Groff MW Khoo L Matz PG et al.; Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 12: pedicle screw fixation as an adjunct to posterolateral fusion for low-back pain. J Neurosurg Spine 2:700–706 2005

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