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.
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Introduction
Degenerative spondylolisthesis (DS) is a pathological condition caused by degenerative alterations in the spine in which one vertebral body is displaced over the one below, and it is commonly associated with spinal stenosis [2, 33].
The first clinical case of spondylolisthesis has been described in Europe in 1782 by a Belgian obstetrician (Herbiniaux) who first named this phenomenon “spondyloptosis,” and depicted this pathological condition as a mechanical hinderance to delivery which reduced the diameter of the pelvic inlet [12]. Nonetheless, the term “spondylolisthesis” was coined for the first time only in 1960 by Newman and Stone [8, 19].
DS results primary from arthritis of the facet joints that thwarts motion of the joint and leads to stress and instability. This, in turn, provokes lessening of the ligamentum flavum, degenerative instability, and consequent anterior displacement of the vertebrae [9, 27].
Both surgical and nonoperative treatments are possible. The former usually involves various types of fusion and stabilization techniques, of which none has yet proven to be superior [5, 18, 34]. Despite the progress made in our understandings of the disease, it has still to be fully established when (and possibly also whether) surgical intervention is superior to conservative treatment [2, 7, 11].
Nevertheless, the number of annual elective lumbar fusions has been on the rise in the last decades with a considerable upward trend of a 118% increase from 1998 to 2014 [29].
The reasons behind such steep increase are multiple and include broader surgical indications, shorter operative durations and significant technological improvements. Moreover, the greater life expectancy of the population and the decrease of post-surgical complication rates have led a growing number of elderlies with DS in their eighties to demand for spinal fusion [15, 23, 29]. It becomes therefore essential to balance benefits and potential complications in these age categories commonly considered as fragile and at risk for such invasive procedures.
Is spinal fusion in patients approaching their nine’s, eight’s and seventh’s decades of life equally safe? Are there some risk factors (i.e., obesity, insulin-dependent and insulin-independent diabetes, use of antiaggregant or anticoagulant therapy, osteoporosis, and ASA IV) in this population that drive the rates of post-operative medical, early surgical, and late surgical complications?
Aim of this study
Our primary objective in this paper was to evaluate whether medical and surgical risks are significantly different between patients in their sixties, seventies, and eighties undergoing open posterolateral arthrodesis with associated spinal decompression. We hypothesize that complication rates between these different age groups are not significantly different as long as premorbid profiles are similar.
Material and methods
Inclusion criteria, surgical technique, and parameters analyzed
In this retrospective study, clinical data were gathered and analyzed from 678 consecutive cases of patients (250 males and 428 females) who underwent arthrodesis using an open posterolateral instrumentation with pedicle screw fixation and laminectomy for spinal decompression. Surgeries were performed between January 2012 and May 2020 in IRCCS Istituto Ortopedico Galeazzi (Gruppo ospedaliero San Donato), Milan, Italy, Columbus Clinic Center, Milan, Italy, and Istituto di Cura Città di Pavia (Gruppo ospedaliero San Donato), Pavia, Italy. Diagnosis was formulated by the first author (E.A.) who also carried out the surgical procedure as the first operator. Data were collected by reviewing hospital charts, admission letters, and follow-up visits. Mean follow-up time was 4 years and 9 months.
Inclusion criteria were 1 or 2 levels of spondylolisthesis, evidence of Schizas grade C or D spinal stenosis on MRI, neurogenic claudication, absence of degenerative scoliosis > 5°, and vertebral instability documented by a dynamic orthostatic X-rays radiography.
Patients that were taking anticoagulant or antiaggregant therapies before surgery underwent a cardiological examination to evaluate the most appropriate Low Molecular Weight Heparin (LMWH) bridging regimen.
Generally, individuals taking warfarin discontinued the drug 5 days prior to the operative intervention with an international normalized ratio’s target inferior to 1.5. Likewise, antiplatelet therapies with either aspirin or plavix were stopped 5 days before fusion and stabilization. Differently, oral direct factor Xa inhibitors (for example rivaroxaban, apixaban, and edoxaban) were suspended 48 h ahead of the surgical procedure.
Usually, all patients under anticoagulant or antiplatelet therapy transited to LMWH; the latter, however, was almost invariably held for 12 to 24 h before surgery. Nevertheless, special situations which required different bridging regimens were adjusted on an individual basis.
All patients underwent perioperative antibiotic therapy which consisted of a standard protocol with 2 g of intravenous cefazolin administrated 2 h before and 6 h after the surgical procedure (except for patients with known allergies to the aforementioned antibiotic therapy).
In every individual, a urinary catheter was placed and subsequently removed after the patient started autonomous mobilization.
Information we searched for (other than age) included postoperative complications and hypothetical preoperative risk factors (Table 1).
More specifically, postoperative complications comprised of the following: (1) Early surgical complications which occurred during the first 15 days from the operation (cerebrospinal fluid (CSF) leak, wound dehiscence, post-surgical hematoma that necessitated incision and drainage, and radicular post-decompressive deficit); (2) Late surgical complications that occurred 15 days after surgery (spondylodiscitis, device mobilization/rupture, and adjacent segment pathology); (3) Medical complications within 3 months from the day of surgery (urinary tract infection (UTI), pneumonia, deep vein thrombosis (DVT), cerebrovascular accident, and cardiological complications).
Risk factors considered included the following: (1) ASA class, (2) BMI, (3) osteoporosis, (4) use of anticoagulants, (5) use of platelet antiaggregants, (6) non-insulin dependent (NID) diabetes mellitus, (7) insulin dependent (ID) diabetes mellitus, (8) sex.
Statistical analysis
Frequency and percentages were utilized to describe categorical variables while mean, ranges, and standard deviations were used for continuous.
Two cases with missing values of one or more predictors were excluded from the regression analysis.
Pearson’s chi-square test was used to compare frequencies between two or more categorical parameters. For every complication considered, we utilized multiple logistic regressions to predict its specific probability of development after surgery. Eight of the predictor variables were categorical while BMI was the only continuous one. Age was considered categorical and divided into 3 groups: (1) patients 60–69 years old, (2) patients 70–79 years old, (3) patients 80 and older. Regression assumptions were not violated and this was checked through tests. All predictors were tested for multicollinearity by calculating their variance inflation factors which were always deemed as acceptable.
Full model was compared with a model of intercept only by means of chi-square test. Furthermore, Hosmer and Lemeshow test was also performed to assure proper goodness-of-fit. For each of the predictors, standardized logistic regression coefficients and p values were calculated.
All P values reported are two-tailed, and P < 0.05 was considered statistically significant.
Computations and graphics were made using R (version 4.1.0) and SPSS (IBM Corp. Release, IBM SPSS Statistics for macOS, Version 26.0).
Results
Table 2 and Graphs 1, 2, and 3 illustrate descriptive statistics. Our cohort averaged 74.61 years (SD = 6.47) and included 188 patients between 60 and 69 years of age, 309 between 70 and 79, and 179 between 80 and 89.
Seventy-nine medical complications were recorded: 24 urinary tract infections, 18 lobar pneumonias, 10 deep vein thrombosis (2 of which were further complicated by pulmonary embolism), 12 cerebrovascular accidents (8 transient ischemic attacks, 4 ischemic strokes, one of which resulted in death), and 15 cardiological complications (8 atrial fibrillations requiring pharmacological treatment, 7 myocardial infarctions including 5 treated with coronary angioplasty and stent placement and 1 fatality).
Fifty-two early surgical complications were also encountered that presented the following distributions: 16 CSF leaks (seven of which required surgical revision), 11 wound dehiscences (nine necessitating reoperation); 13 postsurgical hematomas (all subsequently incised and drained), 12 radicular post decompressive deficits (6 of which did not report any further neurological recovery).
Total late surgical complications were 63 (12 spondylodiscitis, 21 device mobilizations/screw fractures, and 30 adjacent segment diseases). Table 3 summarizes complications’ distribution with their respective percentages.
The different distributions and means of the hypothetical risk factors are analyzed and illustrated in Table 2. More specifically, there were 104 patients in ASA class 1 (15.41%), 250 ASA class 2 (37.04%), 221 with ASA 3 (32.74%), and 100 in a constant threat of life (ASA 4, 14.81%).
Sixty elderlies were under anticoagulant therapy, while 165 under antiaggregant. BMI averaged 26.06 (SD = 2.74). One hundred seventy-six individuals suffered from osteoporosis, while 103 had diabetes mellitus (60 of which were insulin-independent and 43 insulin-dependent).
Statistical analysis demonstrated that the percentage of individuals with ASA 4 and the percentage of patients taking anticoagulant therapy was significantly lower between individuals in their sixties and seventies with respect to those in their eighties (8%, 14.3%, and 23%, respectively for ASA 4 (Χ2 (2) = 39.357, P < 0.001) and 16.7%, 41.7%, and 41.7%, respectively for use of anticoagulants (Χ2 (2) = 8.911, P = 0.012)) which probably accounts for the higher absolute number of medical complications found in the latter group (Χ2 (2) = 9.041, P = 0.003).
A high BMI raises considerably chances of suffering from medical complications, irrespective of age groups (B = 0.366, Wald = 37.701, P < 0.001).
Taking antiaggregant therapy did not increase the risk of developing medical complications in this type of surgery. It may have only a weak correlation with overall early surgical complications (B = 0.910, Wald = 5.895, P = 0.015), especially for what concerns wound dehiscence (B = 1.754, Wald = 4.684, P = 0.030). Similarly, osteoporosis was the only weak significant risk factor that correlated with late surgical complications (B = 0.712, Wald = 3.874, P = 0.049).
Importantly, when controls for the other variables were added to the regression, age was never a significant predictor for any of the above listed complications except cerebrovascular diseases (Table 3 and Table 4) which on the contrary were significant at P = 0.005 (B = 1.745, Wald = 7.715).
Conversely, other risk factors such as ASA (B = 0.888, Wald = 15.019, P < 0.001), ID diabetes (B = 1.734, Wald = 13.896, P < 0.001), and anticoagulant use (B = 1.696, Wald = 16.556, P < 0.001) positively correlated with medical complication rates. Interestingly, NID diabetes had a negative correlation with the latter (B = − 1.051, Wald = 4.090, P = 0.043).
Considered all together, early surgical complications were not different between the three age groups. Post-surgical CSF leaks, hematomas, and neurological deficits were not determined by any other risk factors.
Finally, in our study, ASA and BMI were the two risk factors that positively correlated with the highest number of complications; more specifically, both were associated with UTI, pneumonia, cerebrovascular accidents, and spondylodiscitis, while ASA was with TVP alone and BMI with device mobilization alone as well.
Discussion
In surgical procedures, postoperative morbidity and mortality is historically believed to increase progressively with growing age [6, 17, 21, 31]. Yet, this correlation does not apply uniformly for all types of surgery, and some pose the elderly at higher risk for complications than others [10].
Today, as global population ages (in 2050, the life expectancy is believed to raise to 86.6 and 81.1 years for women and men, respectively) the increased prevalence of degenerative spondylolisthesis is accelerating the demand for spinal fusion in patients 80 years or older, once considered unsuitable candidates [30]. Although elective spinal surgery is often not perceived as lifesaving, withholding it (and therefore leaving conditions like spinal stenosis, disc herniations or segmental instability untreated) has relevant implications for the quality of life of patients. Moreover, due to the significant morbidity of DS, the load on the healthcare is destined to rise substantially in the future.
Predicting preoperative risk is surely an imperfect science that integrates different perspectives also resulting from different needs (i.e., those of the surgeon, of the anesthesiologist, and sometimes of other physicians). Nonetheless, in the last 20 years, a growing number of physicians have been attempting to elaborate different frailty indexes in the process of preoperative risk stratification.
Although many definitions are used, frailty is commonly considered a geriatric syndrome that exposes older adults at a high risk of devastating decline in health and function and predisposes the surgical patient to higher rates of postoperative complications [32]. In literature, 11 different indexes can be found attempting to quantitatively assess frailty in patients undergoing spinal surgeries, and that therefore try to predict the occurrence of postoperative complications. The superiority of one vs the other is a matter of debate, and it is not the intention of the authors to elaborate on the topic [32]. The approach of this study was to test the predictive power of the most commonly diffuse medical conditions on medical, early surgical, and late surgical complications.
Despite the fact that most investigators have limited their studies to patients with less than 70 years of age, the efficacy of spinal fusion in the elderlies has been demonstrated by various retrospective studies [4, 14].
Nonetheless, few authors have analyzed complication rates of spinal surgery in general (i.e., not exclusively restricted to arthrodesis) in patients over 80, and those who did, not only have reported conflicting results but also with small sample sizes; however, spinal fusion is a more invasive surgery with respect to decompression and microdiscectomy, and in line with what other investigators have reported so far, our statistical analysis indicated that octogenarians had significantly higher rates of complications compared to individuals in their seventies or sixties for both medical and surgical complications [3, 17, 22, 26].
But when controls for all other risk factors were added in the analysis, age suddenly was never a significant factor in predicting any of the complications examined. The only noticeable exception was represented by cerebrovascular accidents for which age did exhibit a positive correlation. Perioperative strokes are mostly ischemic and embolic in nature [28]. Surgical trauma with associated tissue injury is a well-known cause of hypercoagulability, but the mechanism by which age probably increases the risk of strokes is constituted by the decreased cerebrovascular reserve and by the many pathological coexisting conditions (i.e., diabetes, hypertension, carotid stenosis, and BPCO) that occur with a higher frequency in older people [28]. Lately, a protective effect on postoperative cerebrovascular accidents has been identified in the use of volatile anesthesia [24].
Likewise, it is also interesting to note that as insulin-dependent diabetes emerged as a strong predictor of medical (mostly cardiological) complications, non-insulin diabetes did not (and even appeared to have a weak inverse correlation). Such impressive discrepancy may be explained by the protective effect (which lately emerged) exerted by metformin, the most-commonly prescribed drug for this condition worldwide, on reducing risk-adjusted mortality, intensive care unit length of stay, and readmission following surgeries [16, 25].
Besides the effect of age, our findings also highlight the powerful impact that a high BMI and high ASA class exert on medical and late surgical complication rates, thus representing the two most influential predictors. In our previous paper, we demonstrated how these two parameters negatively influenced clinical outcome in patients undergoing simple decompressive surgery for spinal stenosis [1]. Our findings in this paper confirm how these two fundamental parameters should be routinely integrated in the process of selection of candidates for lumbar surgery.
Strengths and limitations
With 678 cases of lumbar open posterolateral fusions, our study represents one of the largest multi-center studies evaluating complications of spinal arthrodesis in the elderlies, and especially the one with the highest cohort of cases (179) of patients with more than 80 years. Its considerable mean follow-up time (4 years and 9 months) allowed for a complete assessment of a wide range of both short- and long-term medical and surgical complications. Furthermore, all surgical procedures have been performed by the same surgeon (E.A.), making our study more robust to performance bias.
Nevertheless, some study limitations need to be pointed out. First of all, this study only includes surgically treated patients; therefore, there is a chance that patients with high morbidity profiles may have been excluded from the analysis, resulting in a surgical selection bias which may have hampered the results. Secondly, because of the retrospective nature of the study, it is possible that some of the complications were underreported. The rates of CSF leaks and hardware failure, for example, were low compared to literature [13, 20, 35]. Hindsight bias and recall bias might have influenced the frequencies reported. Thirdly, the risk factors we analyzed are only some among the most widely diffused medical conditions encountered by spinal surgeons in their daily practice, thence do not necessarily represent a complete list of variables that may influence complication rates in the elderlies undergoing lumbar fusions. Other less diffused risk factors may be implicated as well.
Lastly, using a binary classification system to measure complications’ outcomes, although offering greater versatility when interpreting the results, decreases the capacity to detect relationships.
Conclusions
In patients undergoing open lumbar posterolateral arthrodesis and decompression (with vertebral instability documented by a dynamic orthostatic X-rays radiography, 1 or 2 levels, no scoliosis greater than 5°, and Schizas C or D spinal grade of compression) with similar risk factors, the rates of postoperative complications do not increase with increasing age. Instead, complication rates rise uniformly throughout different age groups, along with the presence of important pre-operative risk factors: ASA class IV, high BMI, insulin-dependent diabetes mellitus, and use of anticoagulants for what concerns medical complications; ASA class IV and elevated BMI for spondylodiscitis and elevated BMI with regard to device mobilization/rupture.
Healthy octogenarians are at lower risk for medical and surgical complications than individuals in their sixties with one, or more, risk factors. When selecting the ideal candidates for lumbar fusion surgery, the importance of biological age outweighs that of chronological.
References
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
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.
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
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
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
Dn MOHR (1983) Estimation of surgical risk in the elderly: a correlative review. J Am Geriatr Soc 31(2):99–102
Epstein NE (1998) Decompression in the surgical management of degenerative spondylolisthesis: advantages of a conservative approach. J Spinal Disord 11(2):116–122
Fitzgerald JA, Newman PH (1976) Degenerative spondylolisthesis. The J of bone and joint surg Br vol 58(2):184–92
Gagnet P, Kern K, Andrews K, Elgafy H, Ebraheim N (2018) Spondylolysis and spondylolisthesis: a review of the literature. J Orthop 15(2):404–407
Goodney PP, Siewers AE, Stukel TA, Lucas FL, Wennberg DE, Birkmeyer JD (2002) Is surgery getting safer? National trends in operative mortality. J Am Coll Surg 195(2):219–227. https://doi.org/10.1016/s1072-7515(02)01228-0
Harris IA, Traeger A, Stanford R, Maher CG, Buchbinder R (2018) Lumbar spine fusion: what is the evidence? Intern Med J 48(12):1430–1434
Herbiniaux G (1791). Traité sur divers Accouchemens laborieux et sur les polypes de la matrice. chez Lemaire.
Jankowitz BT, Atteberry DS, Gerszten PC, Karausky P, Cheng BC, Faught R, Welch WC (2009 Aug) Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery. Eur Spine J 18(8):1169–1174
Jo DJ, Jun JK, Kim KT, Kim SM (2010) Lumbar interbody fusion outcomes in degenerative lumbar disease: comparison of results between patients over and under 65 years of age. J of Korean Neurosurg Soc 48(5):412
Kim P, Kurokawa R, Itoki K (2010) Technical advancements and utilization of spine surgery—international disparities in trend-dynamics between Japan, Korea, and the USA. Neurol Med Chir 50(9):853–858
Lin CS, Chang CC, Yeh CC, Chang YC, Chen TL, Liao CC (2020) Outcomes after surgery in patients with diabetes who used metformin: a retrospective cohort study based on a real-world database. BMJ Open Diabetes Research and Care. 8(2):e001351
Marbacher S, Mannion AF, Burkhardt JK, Schär RT, Porchet F, Kleinstück F, Jeszenszky D, Fekete TF, Haschtmann D (2016) Patient-rated outcomes of lumbar fusion in patients with degenerative disease of the lumbar spine does age matter? Spine 41(10):893–900
Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ (2015) Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J of spine surg 1(1):2
Newman PH, Stone KH (1963) The etiology of spondylolisthesis. The J of Bone and Joint Surg Br vol 45(1):39–59
Okuda S, Miyauchi A, Oda T, Haku T, Yamamoto T, Iwasaki M (2006 Apr 1) Surgical complications of posterior lumbar interbody fusion with total facetectomy in 251 patients. J Neurosurg Spine 4(4):304–309
Polanczyk CA, Marcantonio E, Goldman L, Rohde LE, Orav J, Mangione CM, Lee TH (2001) Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Intern Med 134(8):637–43. https://doi.org/10.7326/0003-4819-134-8-200104170-00008
Puvanesarajah V, Jain A, Shimer AL, Li X, Singla A, Shen F, Hassanzadeh H (2017) Complications and mortality following 1 to 2 level lumbar fusion surgery in patients above 80 years of age. Spine 42(6):437–441
Rajaee SS, Bae HW, Kanim LE, Delamarter RB (2012) Spinal fusion in the United States: analysis of trends from 1998 to 2008. Spine 37(1):67–76
Raub D, Platzbecker K, Grabitz SD, Xu X, Wongtangman K, Pham SB, Murugappan KR, Hanafy KA, Nozari A, Houle TT, Kendale SM (2021) Effects of volatile anesthetics on postoperative ischemic stroke incidence. J of the Am Heart Assoc 10(5):e018952
Reitz KM, Marroquin OC, Zenati MS, Kennedy J, Korytkowski M, Tzeng E, Koscum S, Newhouse D, Garcia RM, Vates J, Billiar TR (2020) Association between preoperative metformin exposure and postoperative outcomes in adults with type 2 diabetes. JAMA surg 155(6):e200416
Rihn JA, Hilibrand AS, Zhao W, Lurie JD, Vaccaro AR, Albert TJ, Weinstein J (2015) Effectiveness of surgery for lumbar stenosis and degenerative spondylolisthesis in the octogenarian population: analysis of the Spine Patient Outcomes Research Trial (SPORT) data. The J of bone and joint surg Am vol 97(3):177
Rubery PT (2001) Degenerative spondylolisthesis. Curr Opin Orthop 12(3):183–188
Selim M (2007) Perioperative stroke. N Engl J Med 356(7):706–713
Sheikh SR, Thompson NR, Benzel E, Steinmetz M, Mroz T, Tomic D, Machado A, Jehi L (2020) Can We Justify It? Trends in the utilization of spinal fusions and associated reimbursement. Neurosurg 86(2):E193-202
Szpalski M, Gunzburg R, Mélot C, Aebi M (2005). The aging of the population: a growing concern for spine care in the twenty-first century. InThe Aging Spine (pp. 1–3). Springer, Berlin, Heidelberg.
Turrentine FE, Wang H, Simpson VB, Jones RS (2006) Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg 203(6):865–877
Veronesi F, Borsari V, Martini L, Visani A, Gasbarrini A, Brodano GB, Fini M (2021) The impact of frailty on spine surgery: systematic review on 10 years clinical studies. Aging Dis 12(2):625
Wang YX, Kaplar Z, Deng M, Leung JC (2017) Lumbar degenerative spondylolisthesis epidemiology: a systematic review with a focus on gender-specific and age-specific prevalence. J of orthop transl 11:39–52
Xu DS, Walker CT, Godzik J, Turner JD, Smith W, Uribe JS (2018). Minimally invasive anterior, lateral, and oblique lumbar interbody fusion: a literature review. Annals of translational medicine. 6(6).
Yoshihara H, Yoneoka D (2014 Feb) Incidental dural tear in spine surgery: analysis of a nationwide database. Eur Spine J 23(2):389–394
Acknowledgements
Many thanks to the Fondazione I.E.N. for the scientific support. The authors would also like to thank Dr. Giulio Bonomo for contributing to the revision of the paper during the response to reviewers’ process.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants involved in the study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Spine Degenerative.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Aimar, E., Iess, G., Mezza, F. et al. Complications of degenerative lumbar spondylolisthesis and stenosis surgery in patients over 80 s: comparative study with over 60 s and 70 s. Experience with 678 cases. Acta Neurochir 164, 923–931 (2022). https://doi.org/10.1007/s00701-022-05118-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-022-05118-9