Elderly Patients Have Similar Outcomes Compared to Younger Patients After Minimally Invasive Surgery for Spinal Stenosis
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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.
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.
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.
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).
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.
- 4.Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J. 2008;8:968–974.PubMedCrossRefGoogle Scholar
- 18.Ragab AA, Fye MA, Bohlman HH. Surgery of the lumbar spine for spinal stenosis in 118 patients 70 years of age or older. Spine (Phila Pa 1976). 2003;28:348–353.Google Scholar
- 20.Rampersaud YR, Neary MA, White K. Spine adverse events severity system: content validation and interobserver reliability assessment. Spine (Phila Pa 1976). 2010;35:790–795.Google Scholar
- 22.Rampersaud YR, Wai EK, Fisher CG, Yee AJ, Dvorak MF, Finkelstein JA, Gandhi R, Abraham EP, Lewis SJ, Alexander DI, Oxner WM, Davey JR, Mahomed N. Postoperative improvement in health-related quality of life: a national comparison of surgical treatment for focal (one- to two-level) lumbar spinal stenosis compared with total joint arthroplasty for osteoarthritis. Spine J. 2011;11:1033–1041.PubMedCrossRefGoogle Scholar
- 27.Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson AN, Blood EA, Birkmeyer NJ, Hilibrand AS, Herkowitz H, Cammisa FP, Albert TJ, Emery SE, Lenke LG, Abdu WA, Longley M, Errico TJ, Hu SS. Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med. 2007;356:2257–2270.PubMedCentralPubMedCrossRefGoogle Scholar
- 28.Weinstein JN, Lurie JD, Tosteson TD, Zhao W, Blood EA, Tosteson AN, Birkmeyer N, Herkowitz H, Longley M, Lenke L, Emery S, Hu SS. Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Joint Surg Am. 2009;91:1295–1304.PubMedCentralPubMedCrossRefGoogle Scholar
- 29.Weinstein JN, Tosteson TD, Lurie JD, Tosteson A, Blood E, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976). 2010;35:1329–1338.Google Scholar