Surgical outcomes in the elderly with degenerative spondylolisthesis: comparative study between patients over 80 years of age and under 80 years-a gender-, diagnosis-, and surgical method-matched two-cohort analyses.

BACKGROUND

In Taiwan, the current life expectancy of an 80-year-old man is 88.4 years and that of an 80-year-old is woman is 89.8 years. Surgical candidates older than 80 years usually ask surgeons whether it would be safe for them to undergo surgery.

PURPOSE

The objectives of this study were to report the surgical outcomes of patients with degenerative spondylolisthesis who were older than 80 years and underwent instrumented surgeries and to compare these data with the outcomes of patients aged 65-79 years.

STUDY DESIGN/SETTING: This is a retrospective study.

PATIENT SAMPLE

The study included 76 patients.

OUTCOME MEASURES

The preoperative medical condition was reviewed using the weighted Charlson Comorbidity Index (CCI) and the American Society of Anesthesiologists (ASA) physical status classification. Clinical outcomes were evaluated according to the Oswestry Disability Index (ODI) and the visual analog scale (VAS) for leg and back pain. Plain radiographs were used to assess the fusion status, implant-related complications, and the prevalence of osteoporotic compression fractures (OVFx).

MATERIALS AND METHODS

The study comprised patients older than 80 years, and the control group comprised patients aged 65-79 years. The two cohorts were matched for gender, main diagnosis, and surgical method.

RESULTS

In total, 76 patients were included in the study. The study group had 38 patients with a mean age of 82.4 years (80-93 years); the control group also had 38 patients with a mean age of 70.8 years (65-79 years). The study group had a significantly higher ASA classification (2.94 vs. 2.76, p=.040) and CCI score (1.84 vs. 1.13, p=.012). The study group had a higher prevalence of preoperative OVFx (10.5% vs. 2.6%, p=.116) and incidence of new-onset OVFx (13.2% vs. 2.6%, p=.089). The study group had longer operative times (204.6 vs. 179.1 minutes, p=.052) with more blood loss (606.5 vs. 525.8 mL, p=.512), but this finding was not statistically significant. The mean ODI and VAS scores were similar between the two groups. The bone union rate was superior in the control group (81.6% vs. 89.5%, p=.328).

CONCLUSIONS

Patients older than 80 years have a higher osteoporotic status and comorbidities, which may lead to longer operative times and greater blood loss, with poorer radiographic outcomes. However, the clinical results were not affected. With appropriate patient selection, the age of >80 years is not a negative predictive factor for instrumented surgery for degenerative spondylolisthesis.