Yonsei Med J.  2015 Sep;56(5):1199-1205. 10.3349/ymj.2015.56.5.1199.

Outcome and Complications in Surgical Treatment of Lumbar Stenosis or Spondylolisthesis in Geriatric Patients

• Lee JY
• Moon SH
• Suh BK
• Yang MH
• Park MS

• KMID: 2163609
• DOI: http://doi.org/10.3349/ymj.2015.56.5.1199

Abstract

Development of anesthesiology and improvement of surgical instruments enabled aggressive surgical treatment even in elderly patients, who require more active physical activities than they were in the past. However, there are controversies about the clinical outcome of spinal surgery in elderly patients with spinal stenosis or spondylolisthesis. The purpose of this study is to review the clinical outcome of spinal surgery in elderly patients with spinal stenosis or spondylolisthesis. MEDLINE search on English-language articles was performed. There were 39685 articles from 1967 to 2013 regarding spinal disease, among which 70 dealt with geriatric lumbar surgery. Eighteen out of 70 articles dealt with geriatric lumbar surgery under the diagnosis of spinal stenosis or spondylolisthesis. One was non-randomized prospective, and other seventeen reports were retrospective. One non-randomized prospective and twelve out of seventeen retrospective studies showed that old ages did not affect the clinical outcomes. One non-randomized prospective and ten of seventeen retrospective studies elucidated postoperative complications: some reports showed that postoperative complications increased in elderly patients, whereas the other reports showed that they did not increase. Nevertheless, most complications were minor. There were two retrospective studies regarding the mortality. Mortality which was unrelated to surgical procedure increased, but surgical procedure-related mortality did not increase. Surgery as a treatment option in the elderly patients with the spinal stenosis or spondylolisthesis may be reasonable. However, there is insufficient evidence to make strong recommendations regarding spinal surgery for geriatric patients with spinal stenosis and spondylolisthesis.

Keyword

Spinal surgery; geriatric patient; spinal stenosis; spondylolisthesis

MeSH Terms

Aged
Aged, 80 and over
Constriction, Pathologic
Decompression, Surgical/*methods
Female
Humans
*Lumbar Vertebrae
Male
Patients
Postoperative Complications/diagnosis
Spinal Stenosis/*surgery
Spondylolisthesis/*surgery
Surgical Instruments
Treatment Outcome

Reference

1. Glassman SD, Polly DW, Bono CM, Burkus K, Dimar JR. Outcome of lumbar arthrodesis in patients sixty-five years of age or older. J Bone Joint Surg Am. 2009; 91:783–790.

2. Glassman SD, Carreon LY, Dimar JR, Campbell MJ, Puno RM, Johnson JR. Clinical outcomes in older patients after posterolateral lumbar fusion. Spine J. 2007; 7:547–551.

3. Okuda S, Oda T, Miyauchi A, Haku T, Yamamoto T, Iwasaki M. Surgical outcomes of posterior lumbar interbody fusion in elderly patients. J Bone Joint Surg Am. 2006; 88:2714–2720.

4. Arinzon ZH, Fredman B, Zohar E, Shabat S, Feldman JS, Jedeikin R, et al. Surgical management of spinal stenosis: a comparison of immediate and long term outcome in two geriatric patient populations. Arch Gerontol Geriatr. 2003; 36:273–279.

5. Rihn JA, Hilibrand AS, Zhao W, Lurie JD, Vaccaro AR, Albert TJ, et al. Effectiveness of surgery for lumbar stenosis and degenerative spondylolisthesis in the octogenarian population: analysis of the Spine Patient Outcomes Research Trial (SPORT) data. J Bone Joint Surg Am. 2015; 97:177–185.

6. Crawford CH 3rd, Smail J, Carreon LY, Glassman SD. Health-related quality of life after posterolateral lumbar arthrodesis in patients seventy-five years of age and older. Spine (Phila Pa 1976). 2011; 36:1065–1068.

7. Shabat S, Arinzon Z, Folman Y, Leitner J, David R, Pevzner E, et al. Long-term outcome of decompressive surgery for lumbar spinal stenosis in octogenarians. Eur Spine J. 2008; 17:193–198.

8. Fredman B, Arinzon Z, Zohar E, Shabat S, Jedeikin R, Fidelman ZG, et al. Observations on the safety and efficacy of surgical decompression for lumbar spinal stenosis in geriatric patients. Eur Spine J. 2002; 11:571–574.

9. Tokuhashi Y, Ajiro Y, Umezawa N. Outcomes of posterior fusion using pedicle screw fixation in patients >or=70 years with lumbar spinal canal stenosis. Orthopedics. 2008; 31:1096.

10. Vitaz TW, Raque GH, Shields CB, Glassman SD. Surgical treatment of lumbar spinal stenosis in patients older than 75 years of age. J Neurosurg. 1999; 91:2 Suppl. 181–185.

11. 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.

12. Sanderson PL, Wood PL. Surgery for lumbar spinal stenosis in old people. J Bone Joint Surg Br. 1993; 75:393–397.

13. Jönsson B, Strömqvist B. Lumbar spine surgery in the elderly. Complications and surgical results. Spine (Phila Pa 1976). 1994; 19:1431–1435.

14. Carreon LY, Puno RM, Dimar JR 2nd, Glassman SD, Johnson JR. Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am. 2003; 85-A:2089–2092.

15. Kilinçer C, Steinmetz MP, Sohn MJ, Benzel EC, Bingaman W. Effects of age on the perioperative characteristics and short-term outcome of posterior lumbar fusion surgery. J Neurosurg Spine. 2005; 3:34–39.

16. Raffo CS, Lauerman WC. Predicting morbidity and mortality of lumbar spine arthrodesis in patients in their ninth decade. Spine (Phila Pa 1976). 2006; 31:99–103.

17. Oldridge NB, Yuan Z, Stoll JE, Rimm AR. Lumbar spine surgery and mortality among Medicare beneficiaries, 1986. Am J Public Health. 1994; 84:1292–1298.

18. Kim HJ, Lee HM, Kim HS, Moon ES, Park JO, Lee KJ, et al. Life expectancy after lumbar spine surgery: one- to eleven-year follow-up of 1015 patients. Spine (Phila Pa 1976). 2008; 33:2116–2121.

19. Cloyd JM, Acosta FL Jr, Ames CP. Complications and outcomes of lumbar spine surgery in elderly people: a review of the literature. J Am Geriatr Soc. 2008; 56:1318–1327.

20. Deyo RA, Cherkin DC, Loeser JD, Bigos SJ, Ciol MA. Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure. J Bone Joint Surg Am. 1992; 74:536–543.

21. Chang Y, Singer DE, Wu YA, Keller RB, Atlas SJ. The effect of surgical and nonsurgical treatment on longitudinal outcomes of lumbar spinal stenosis over 10 years. J Am Geriatr Soc. 2005; 53:785–792.

22. Benz RJ, Ibrahim ZG, Afshar P, Garfin SR. Predicting complications in elderly patients undergoing lumbar decompression. Clin Orthop Relat Res. 2001; 116–121.

23. Daubs MD, Lenke LG, Cheh G, Stobbs G, Bridwell KH. Adult spinal deformity surgery: complications and outcomes in patients over age 60. Spine (Phila Pa 1976). 2007; 32:2238–2244.

24. Acosta FL Jr, McClendon J Jr, O'Shaughnessy BA, Koller H, Neal CJ, Meier O, et al. Morbidity and mortality after spinal deformity surgery in patients 75 years and older: complications and predictive factors. J Neurosurg Spine. 2011; 15:667–674.

25. Atlas SJ, Deyo RA, Keller RB, Chapin AM, Patrick DL, Long JM, et al. The Maine Lumbar Spine Study, Part III. 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis. Spine (Phila Pa 1976). 1996; 21:1787–1794.

26. Atlas SJ, Keller RB, Robson D, Deyo RA, Singer DE. Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the maine lumbar spine study. Spine (Phila Pa 1976). 2000; 25:556–562.

27. Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE. Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the maine lumbar spine study. Spine (Phila Pa 1976). 2005; 30:936–943.

28. Amundsen T, Weber H, Nordal HJ, Magnaes B, Abdelnoor M, Lilleâs F. Lumbar spinal stenosis: conservative or surgical management?: a prospective 10-year study. Spine (Phila Pa 1976). 2000; 25:1424–1435.