Adult spine deformity surgery in elderly patients: are outcomes worse in patients 75 years and older?

Abstract

Study design

Retrospective study of a prospectively collected database at one center.

Objectives

Assess the outcomes and complications of adult spinal deformity (ASD) surgery in patients that are 75 years and older compared with patients of 65–75 years of age.

Summary of background data

With increasing amounts of ASD surgery being performed on elderly patients, it is important to assess how age plays a factor in corrective reconstruction surgery.

Methods

Inclusion criteria for the study were all patients ≥ 65 years of age that underwent thoracolumbar deformity correction involving ≥ four levels at a single institution by two surgeons. Patients were divided based on age into 65–74.9 or ≥ 75 groups. Radiographic parameters were measured preoperatively, postoperatively, and at 2 years. The Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI) were collected preoperatively, at 1 year, and 2 years. Comorbidities included were based around the Charlson Comorbidity Index (CCI) and compared to the incidence of complications and need for further surgery.

Results

Both age groups had improvements in their radiographic parameters postoperatively which was maintained at 2 years. Comparing the different age groups with similar comorbidity burden in regard to complications and need for additional surgery yielded no statistically significant difference between groups. Both groups had comparable decreases in NRS and increases in ODI at 2 years.

Conclusions

Analysis of our study population indicates that there is no difference between the outcomes and complications of deformity surgery in patients 75 years and older when compared to a younger elderly population. It also does not appear that a ≥ 3 comorbidity burden has a significant impact on the complications or need for additional surgery in our elderly spinal deformity surgery population.

Level of evidence

Level IV.

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References

  1. 1.

    Schwab F, Dubey A, Gamez L, El Fegoun AB, Hwang K, Pagala M et al (2005) Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine 30:1082–1085

    Article  Google Scholar 

  2. 2.

    Pellisé F, Vila-Casademunt A, Ferrer M, Domingo-Sàbat M, Bagó J, Pérez-Grueso FJS et al (2015) Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions. Eur Spine J 24:3–11. https://doi.org/10.1007/s00586-014-3542-1

    Article  PubMed  Google Scholar 

  3. 3.

    McCarthy I, Hostin R, O’Brien M, Saigal R, Ames CP (2013) Health economic analysis of adult deformity surgery. Neurosurg Clin N Am 24:293–304. https://doi.org/10.1016/j.nec.2012.12.005

    Article  PubMed  Google Scholar 

  4. 4.

    Sing DC, Berven SH, Burch S, Metz LN (2017) Increase in spinal deformity surgery in patients age 60 and older is not associated with increased complications. Spine J 17:627–635. https://doi.org/10.1016/j.spinee.2016.11.005

    Article  PubMed  Google Scholar 

  5. 5.

    Worley N, Marascalchi B, Jalai CM, Yang S, Diebo B, Vira S et al (2016) Predictors of inpatient morbidity and mortality in adult spinal deformity surgery. Eur Spine J 25:819–827. https://doi.org/10.1007/s00586-015-4104-x

    Article  PubMed  Google Scholar 

  6. 6.

    Shaw R, Skovrlj B, Cho SK (2016) Association between age and complications in adult scoliosis surgery: an analysis of the scoliosis research society morbidity and mortality database. Spine 41:508–514. https://doi.org/10.1097/BRS.0000000000001239

    Article  PubMed  Google Scholar 

  7. 7.

    Drazin D, Al-Khouja L, Lagman C, Ugiliweneza B, Shweikeh F, Johnson JP et al (2016) Scoliosis surgery in the elderly: complications, readmissions, reoperations and mortality. J Clin Neurosci 34:158–161. https://doi.org/10.1016/j.jocn.2016.06.005

    Article  PubMed  Google Scholar 

  8. 8.

    Carreon LY, Puno RM, Dimar JR, Glassman SD, Johnson JR (2003) Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am 85-A:2089–2092

    Article  Google Scholar 

  9. 9.

    Smith JS, Shaffrey CI, Glassman SD, Berven SH, Schwab FJ, Hamill CL et al (2011) Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age. Spine 36:817–824. https://doi.org/10.1097/BRS.0b013e3181e21783

    Article  PubMed  Google Scholar 

  10. 10.

    Crawford CH, Carreon LY, Bridwell KH, Glassman SD (2012) Long fusions to the sacrum in elderly patients with spinal deformity. Eur Spine J 21:2165–2169. https://doi.org/10.1007/s00586-012-2310-3

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Hassanzadeh H, Jain A, El Dafrawy MH, Ain MC, Skolasky RL, Kebaish KM (2013) Clinical results and functional outcomes in adult patients after revision surgery for spinal deformity correction: patients younger than 65 years versus 65 years and older. Spine Deform 1:371–376. https://doi.org/10.1016/j.jspd.2013.07.003

    Article  PubMed  Google Scholar 

  12. 12.

    Youssef JA, Orndorff DO, Patty CA, Scott MA, Price HL, Hamlin LF et al (2013) Current status of adult spinal deformity. Global Spine J 3:51–62. https://doi.org/10.1055/s-0032-1326950

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Bridwell KH, Glassman S, Horton W, Shaffrey C, Schwab F, Zebala LP et al (2009) Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study. Spine 34:2171–2178. https://doi.org/10.1097/BRS.0b013e3181a8fdc8

    Article  PubMed  Google Scholar 

  14. 14.

    Li G, Passias P, Kozanek M, Fu E, Wang S, Xia Q et al (2009) Adult scoliosis in patients over sixty-five years of age: outcomes of operative versus nonoperative treatment at a minimum two-year follow-up. Spine 34:2165–2170. https://doi.org/10.1097/BRS.0b013e3181b3ff0c

    Article  PubMed  Google Scholar 

  15. 15.

    Sciubba DM, Scheer JK, Yurter A, Smith JS, Lafage V, Klineberg E et al (2016) Patients with spinal deformity over the age of 75: a retrospective analysis of operative versus non-operative management. Eur Spine J 25:2433–2441. https://doi.org/10.1007/s00586-015-3759-7

    Article  PubMed  Google Scholar 

  16. 16.

    Sciubba DM, Yurter A, Smith JS, Kelly MP, Scheer JK, Goodwin CR et al (2015) A comprehensive review of complication rates after surgery for adult deformity: a reference for informed consent. Spine Deform 3:575–594. https://doi.org/10.1016/j.jspd.2015.04.005

    Article  PubMed  Google Scholar 

  17. 17.

    Jain A, Hassanzadeh H, Puvanesarajah V, Klineberg EO, Sciubba DM, Kelly MP et al (2017) Incidence of perioperative medical complications and mortality among elderly patients undergoing surgery for spinal deformity: analysis of 3519 patients. J Neurosurg Spine 27:534–539. https://doi.org/10.3171/2017.3.SPINE161011

    Article  PubMed  Google Scholar 

  18. 18.

    Soroceanu A, Burton DC, Oren JH, Smith JS, Hostin R, Shaffrey CI et al (2016) Medical complications after adult spinal deformity surgery: incidence, risk factors, and clinical impact. Spine 41:1718–1723. https://doi.org/10.1097/BRS.0000000000001636

    Article  PubMed  Google Scholar 

  19. 19.

    Drazin D, Shirzadi A, Rosner J, Eboli P, Safee M, Baron EM et al (2011) Complications and outcomes after spinal deformity surgery in the elderly: review of the existing literature and future directions. Neurosurg Focus 31:E3. https://doi.org/10.3171/2011.7.FOCUS11145

    Article  PubMed  Google Scholar 

  20. 20.

    Lonergan T, Place H, Taylor P (2016) Acute complications after adult spinal deformity surgery in patients aged 70 years and older. Clin Spine Surg 29:314–317. https://doi.org/10.1097/BSD.0b013e3182764a23

    Article  PubMed  Google Scholar 

  21. 21.

    Sansur CA, Smith JS, Coe JD, Glassman SD, Berven SH, Polly DW et al (2011) Scoliosis research society morbidity and mortality of adult scoliosis surgery. Spine 36:E593–E597. https://doi.org/10.1097/BRS.0b013e3182059bfd

    Article  PubMed  Google Scholar 

  22. 22.

    Cho K-J, Suk S-I, Park S-R, Kim J-H, Kim S-S, Choi W-K et al (2007) Complications in posterior fusion and instrumentation for degenerative lumbar scoliosis. Spine 32:2232–2237. https://doi.org/10.1097/BRS.0b013e31814b2d3c

    Article  PubMed  Google Scholar 

  23. 23.

    Scheer JK, Tang JA, Smith JS, Klineberg E, Hart RA, Mundis GM et al (2013) Reoperation rates and impact on outcome in a large, prospective, multicenter, adult spinal deformity database: clinical article. J Neurosurg Spine 19:464–470. https://doi.org/10.3171/2013.7.SPINE12901

    Article  PubMed  Google Scholar 

  24. 24.

    Scheer JK, Mundis GM, Klineberg E, Hart RA, Deviren V, Burton DC et al (2016) Recovery following adult spinal deformity surgery: the effect of complications and reoperation in 149 patients with 2-year follow-up. Eur Spine J 25:2612–2621. https://doi.org/10.1007/s00586-015-3787-3

    Article  PubMed  Google Scholar 

  25. 25.

    Scheer JK, Mundis GM, Klineberg E, Hart RA, Deviren V, Nguyen S et al (2015) Postoperative recovery after adult spinal deformity surgery: comparative analysis of age in 149 patients during 2-year follow-up. Spine 40:1505–1515. https://doi.org/10.1097/BRS.0000000000001062

    Article  PubMed  Google Scholar 

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Funding

This study was self-funded. No corporate or industry funds were received in support of this work.

Author information

Affiliations

Authors

Contributions

ZL, DD, AC, DC, JR, MC: conception/design, ZL, AC: data collection, AC: Data Analysis and interpretation/stats, ZL, DD, AC, DC, JR, MC: Drafting of manuscript, ZL, DD, AC, DC, JR, MC: Manuscript Revision, DC, JR, MC: Supervision/administration, ZL, DD, AC, DC, JR, MC: Approval of Final manuscript

Corresponding author

Correspondence to David G. Deckey.

Ethics declarations

Conflict of interest

MSC reports consulting fees from Orthofix, Stryker, Depuy, SpineWave, and BK; DGC reports royalties from Spinewave and Medtronic, stock ownership in Handel, and consulting fees from U&I and SpineWave; all other others have no relevant financial disclosures.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Sonoran Spine Center and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. IRB approval was granted at Sonoran Spine Research and Education Foundation.

Informed consent

Informed consent was obtained from patients prior to inclusion in this study.

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Lovato, Z.R., Deckey, D.G., Chung, A.S. et al. Adult spine deformity surgery in elderly patients: are outcomes worse in patients 75 years and older?. Spine Deform (2020). https://doi.org/10.1007/s43390-020-00169-3

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Keywords

  • Outcomes
  • Geriatrics
  • Complications
  • Comorbidities
  • Radiographic parameters
  • Age