80 Year Olds CAN Safely Undergo Spine Surgery

A new study appearing in the February 4th issue of The Journal of Bone & Joint Surgery (JBJS) found that those 80 and older can derive significant benefit from surgical treatment for lumbar spinal stenosis with and without degenerative spondylolisthesis. And the bonus? These patients had no higher overall complication rate and no higher mortality when compared to patients younger than age 80.

In this study, led by Jeffrey A. Rihn, M.D., an orthopedic surgeon at the Rothman Institute, researchers reviewed Spine Patient Outcomes Research Trial (SPORT) data for 105 patients, age 80 and older, and 1, 130 patients younger than age 80 with lumbar stenosis alone or combined with degenerative spondylolisthesis.

The researchers found that 55.2% of the patients who were at least 80 years old underwent surgery—either a spinal fusion (arthrodesis) or a laminectomy—as did 66.3% of the patients under age 80. At baseline, patients age 80 and older had a higher prevalence of hypertension, heart disease, osteoporosis and joint problems, but a lower BMI, and a lower prevalence of depression and smoking. Among the other findings noted in the February 4, 2015 news release:

• Averaged over a four-year follow-up period, operatively treated patients at least 80 years of age, had significantly greater improvement in all primary and secondary outcome measures compared with patients at least 80 years of age who received nonsurgical treatment.
• Both groups—under and over age 80—had comparable rates of complications during and after surgery, reoperations and postoperative mortality.
• Patients age 80 and older had a significantly greater proportion of multi-level lumbar laminectomies (those involving three or more levels of the spine) compared with younger patients (60% versus 32%).
• The benefits of surgery in patients at least 80 years of age were similar to those in younger patients, except for the outcome measures of pain and physical function, which were higher in the under age 80 group.

Asked how he would approach the cost effectiveness issue, Dr. Rihn, an associate professor at Thomas Jefferson University Hospital in Philadelphia, told OTW, “In the current healthcare environment it is important to consider the cost-effectiveness of the treatments we provide. The cost-effectiveness of the surgical management of lumbar stenosis and degenerative spondylolisthesis has already been published from the SPORT data. This cost-effectiveness data was not specific to the patients over the age of 80 years. Given the significant benefit that surgery provided compared to nonsurgical treatment in the patients over the age of 80 and the similar complication rate, I would expect that the cost-effectiveness for treating the patients in this subgroup would be similar to that already published for the whole cohort of patients. This could be determined more definitively using similar methods already published using the SPORT data.”

He added, “Based on our own experience, we were not surprised that patients over the age of 80 years old did well with surgical management of these disabling spinal conditions. This study did not look at patients with significant degenerative scolioisis, which can be a challenging problem to treat particularly in this age group. But for elderly patients with stenosis, with or without degenerative spondylolisthesis, a laminectomy with possibly a non instrumented or even instrumented fusion can provide significant benefit as demonstrated in this study. It was somewhat surprising that there was not a higher complication rate in this patient population given their advanced age and greater baseline medical comorbidities. This finding, however, suggests that surgery can be a relatively safe option for treating these conditions in this patient population.”