Abstract
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.
Publisher
Springer Science and Business Media LLC
Subject
Neurology (clinical),Surgery
Reference35 articles.
1. Aimar E, Iess G, Gaetani P, Galbiati TF, Isidori A, Lavanga V, Longhitano F, Menghetti C, Messina AL, Zekaj E, Broggi G (2021) Degenerative lumbar stenosis surgery: predictive factors of clinical outcome—experience with 1001 patients. World Neurosurg 147:e306–e314. https://doi.org/10.1016/j.wneu.2020.12.048
2. Caelers IJ, Rijkers K, van Hemert WL, de Bie RA, van Santbrink H (2019). Lumbar spondylolisthesis; common, but surgery is rarely needed. Nederlands tijdschrift voor geneeskunde. 163.
3. Carreon LY, Puno RM, Dimar JR, Glassman SD, Johnson JR (2003) Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. JBJS 85(11):2089–2092. https://doi.org/10.2106/00004623-200311000-00004
4. Crawford CH III, Smail J, Carreon LY, Glassman SD (2011) Health-related quality of life after posterolateral lumbar arthrodesis in patients seventy-five years of age and older. Spine 36(13):1065–1068
5. Divi SN, Schroeder GD, Goyal DK, Radcliff KE, Galetta MS, Hilibrand AS, Anderson DG, Kurd MF, Rihn JA, Kaye ID, Woods BR (2019) Fusion technique does not affect short-term patient-reported outcomes for lumbar degenerative disease. The Spine J 19(12):1960–8