Elderly Patients Have Similar Outcomes Compared to Younger Patients After Minimally Invasive Surgery for Spinal Stenosis

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Topic
Spine

Abstract

Background

Older patients undergo surgery for lumbar spinal stenosis in great numbers, but as a result of substantial diagnostic and surgical heterogeneity, the impact of age on results after surgery is poorly defined.

Questions/purposes

We compared groups of patients younger and older than 70 years with relative clinical and surgical homogeneity to determine differences in (1) interval improvement in Oswestry Disability Index (ODI) at 6 weeks, 6 months, and 12 months postoperatively and (2) perioperative adverse events.

Methods

We performed a subgroup analysis of an ongoing prospective observational study. Patients were divided based primarily on age (younger than 70 years [n = 68] and 70 years or older [n = 41]) and secondarily on procedure (minimally invasive decompression alone or decompression and instrumented fusion). With the exception of age and American Society of Anesthesiologists status, the two age groups were similar (p > 0.3) in baseline demographics and ODI. Mean pre- and postoperative ODI were compared between groups at 6 weeks, 6 months, and 12 months. Perioperative adverse events were also compared.

Results

At all time intervals, both younger and older patients demonstrated (p = 0.05 to < 0.001) improvements in ODI. At the 1-year mark, no differences in ODI were demonstrated between the younger and older patients for decompression only (21 versus 26 [p = 0.29]) or decompression and fusion (19 versus 18 [p = 0.97]). Interval improvement in ODI was not different between younger and older patients at any time point for decompression only (6 weeks: −18 versus −20 [p = 0.66]; 6 months: −21 versus −17 [p = 0.41]; 12 months: −21 versus −15 [p = 0.29]) or decompression and fusion (6 weeks: −11 versus −12 [p = 0.58]; 6 months: −21 versus −22 [p = 0.69]; 12 months: −23 versus −27 [p = 0.97]). There were no differences in perioperative adverse events between groups (p = 0.67).

Conclusions

When clinical and surgical heterogeneity is minimized, improvements in terms of disability as measured by the ODI and the frequency of adverse events after surgery in elderly patients with lumbar spinal stenosis are comparable to those of younger patients. For patients with focal lumbar spinal stenosis, age alone should not dissuade us from considering surgical intervention if otherwise indicated.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

One of the authors (YRR) certifies that he or she, or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of USD 10,000 to 100,000 from Medtronic (Memphis, TN, USA). Funding for this project was received from the Toronto General and Western Hospital Foundation, Minimal Access Ambulatory Spine Surgery Research and Education Program (Toronto, Ontario, Canada).
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
This work was performed at the University Health Network, University of Toronto, Toronto, Ontario, Canada.