Tan Jiong Hao Jonathan, Hallinan James Thomas Patrick Decourcy, Ang Shi Wei, Tan Tuan Hao, Tan Hwee Inn Joelle, Tan Le Tian Isaac, Sin Qinxiang Shant, Lee Renick, Hey Hwee Weng Dennis, Chan Yiong Huak, Liu Ka Po Gabriel, Kumar Naresh
Department of Orthopaedic Surgery, National University Health System, Singapore.
Department of Diagnostic Imaging, National University Hospital, Singapore.
Global Spine J. 2025 Mar;15(2):731-741. doi: 10.1177/21925682231209624. Epub 2023 Oct 25.
Retrospective cohort study.
Physicians may be deterred from operating on elderly patients due to fears of poorer outcomes and complications. We aimed to compare the outcomes of surgical treatment of spinal metastases patients aged ≥70-yrs and <70-yrs.
This is a retrospective study of patients surgically treated for metastatic epidural spinal cord compression and spinal instability between January-2005 to December-2021. Follow-up was till death or minimum 1-year post-surgery. Outcomes included post-operative neurological status, ambulatory status, medical and surgical complications. Two Sample -test/Mann Whitney U test were used for numerical variables and Pearson Chi-Squared or Fishers Exact test for categorical variables. Survival was presented with a Kaplan-Meier curve. < .05 was significant.
We identified 412 patients of which 29 (7.1%) patients were excluded due to loss to follow-up and previous surgical treatment. 79 (20.6%) were ≥70-yrs. Age ≥70-yrs patients had poorer ECOG scores ( = .0017) and Charlson Comorbidity Index ( < .001). No significant difference in modified Tokuhashi score ( = .393) was observed with significantly more ≥ prostate ( < .001) and liver ( = .029) cancer in ≥70-yrs. Improved or maintained normal neurological function ( = .934), independent ambulatory status ( = .171), and survival at 6 months ( = .119) and 12 months ( = .659) was not significantly different between both groups. Medical ( = .528) or surgical ( = .466) complication rates and readmission rates ( = .800) were similar.
≥70-yrs patients have comparable outcomes to <70-yr old patients with no significant increase in complication rates. Age should not be a determining factor in deciding surgical management of spinal metastases.
回顾性队列研究。
由于担心预后较差和出现并发症，医生可能不愿为老年患者进行手术。我们旨在比较年龄≥70岁和＜70岁的脊柱转移瘤患者的手术治疗效果。
这是一项对2005年1月至2021年12月期间因转移性硬膜外脊髓压迫和脊柱不稳定而接受手术治疗的患者的回顾性研究。随访至死亡或术后至少1年。结果包括术后神经功能状态、活动状态、医疗和手术并发症。数值变量采用两样本t检验/曼-惠特尼U检验，分类变量采用Pearson卡方检验或Fisher精确检验。生存情况用Kaplan-Meier曲线表示。P＜0.05具有显著性。
我们共纳入412例患者，其中29例（7.1%）因失访和既往手术治疗而被排除。79例（20.6%）年龄≥70岁。年龄≥70岁的患者ECOG评分较差（P = 0.0017），查尔森合并症指数较低（P＜0.001）。改良Tokuhashi评分无显著差异（P = 0.393），年龄≥70岁的患者中前列腺癌（P＜0.001）和肝癌（P = 0.029）明显更多。两组在改善或维持正常神经功能（P = 0.934）、独立活动状态（P = 0.171）以及6个月（P = 0.119）和12个月（P = 0.659）生存率方面无显著差异。医疗并发症发生率（P = 0.528）、手术并发症发生率（P = 0.466）和再入院率（P = 0.800）相似。
年龄≥70岁的患者与年龄＜70岁的患者手术效果相当，并发症发生率无显著增加。年龄不应成为决定脊柱转移瘤手术治疗的决定性因素。
