Does Advancing Age Adversely Influence Outcomes following Lumbar Fusion Surgery?
– A Retrospective Cohort Study
Podium presentation at North American Spine Society
30th Annual Scientific Meeting
Chicago, October 14th 2015
30th Annual Scientific Meeting
Chicago, October 14th 2015
Abstract
Background Context:
Studies have shown that surgical outcomes following lumbar spinal fusion for degenerative conditions may be as good as those following successfully regarded large joint replacement surgery. Little information exists however regarding the results of lumbar fusion surgery in the elderly and especially, in patients over 80-years of age. Given the substantial cost of fusion surgery and projections that the proportion of persons aged 80 or over will increase almost fourfold over the next 50 years, the relative efficacy of fusion surgery in such elderly patients will be of increasing interest.
Purpose:
To determine whether advancing age adversely affects post-operative clinical outcomes in patients undergoing lumbar fusion surgery for similar degenerative pathology and indications.
Study Design/Setting:
A retrospective review of a prospective adult spinal surgical database.
Patient Sample:
One hundred sixty-three consecutive, previously un-operated patients, aged 33 to 89-years who were suffering from single-level, lumbar canal stenosis with an associated degenerative spondylolisthesis and were managed with open decompression and posterior lumbar interbody fusion (PLIF) by a single-surgeon between October 2000 and January 2014.
Outcome Measures:
Visual analog scale (VAS) back and leg pain, Oswestry Disability Index (ODI) and 36-Item Short-Form Health Survey (SF-36, physical component score [PCS] and mental component score [MCS])
Methods:
Patients were stratified to age groups: 80+years (80’s, n=22), 70-79 (70’s, n=55), 60-69 (60’s, n=54), and <60-years (<60, n=32). Differences between patient age groups and HRQOL outcomes were examined pre-operatively and at 6-, 12- and 24-months and at final follow-up (f/u). Minimum clinically important improvements were set at 25-points for VAS pain, 15-points for ODI and 6.2-points for SF-36 PCS. Non parametric statistical analysis was used with XLSTAT Version 2015.1.01. Significance was set at p<0.05.
Results:
Median times to last f/u were similar for the four age groups: 24 (range:12-57), 24 (12-69), 25 (12-65) & 25 (12-120) months, respectively for the 80’s, 70’s, 60’s & <60 groups. For each of these age groups, the mean pre-op VAS back pain scores (±standard deviation) were: 63±20, 48±27, 54±29 and 54±23. At last f/u the VAS scores improved to 23±25, 14±22, 20±23 and 21±23. The mean pre-op ODI scores were 45.0±15.3, 39.3±18.0, 44.2±15.2 and 43.1±13.7 and at last f/u: 22.0±12.9, 18.2±18.0, 17.3±19.9 & 15.8±16.4. 80% of patients in the 80’s group achieved a clinically important improvement in ODI, compared with 66%, 80% and 73% of patients in the 70’s, 60’s and <60 groups. There were no significant differences between age groups in mean VAS or ODI change scores. For SF-36 PCS, pre-op scores for the 4 groups were: 29.7±9.3, 31.3±9.5, 28.9±8.1 & 32.5±8.7 and at last f/u: 36.4±10.5, 41.7±11.6, 42.4±11.9 & 44.2±11.5. The mean SF-36PCS change score for the 80’s group (6.3±10.8) was less than that observed for the 60’s & <60 groups (13.5±11.1 & 11.9±9.6, p=0.03).
Conclusions:
While undertaking major surgery in elderly patients should always be approached with caution, the current study appears to show that improvements in certain Health-Related Quality-Of-Life outcome measures (back pain and ODI) were not adversely affected by advancing age in patients undergoing lumbar fusion surgery for the single level degenerative pathology examined. The poorer SF-36 PCS scores observed at f/u in older age groups may, at least in part, reflect normal age-related patterns.
Background Context:
Studies have shown that surgical outcomes following lumbar spinal fusion for degenerative conditions may be as good as those following successfully regarded large joint replacement surgery. Little information exists however regarding the results of lumbar fusion surgery in the elderly and especially, in patients over 80-years of age. Given the substantial cost of fusion surgery and projections that the proportion of persons aged 80 or over will increase almost fourfold over the next 50 years, the relative efficacy of fusion surgery in such elderly patients will be of increasing interest.
Purpose:
To determine whether advancing age adversely affects post-operative clinical outcomes in patients undergoing lumbar fusion surgery for similar degenerative pathology and indications.
Study Design/Setting:
A retrospective review of a prospective adult spinal surgical database.
Patient Sample:
One hundred sixty-three consecutive, previously un-operated patients, aged 33 to 89-years who were suffering from single-level, lumbar canal stenosis with an associated degenerative spondylolisthesis and were managed with open decompression and posterior lumbar interbody fusion (PLIF) by a single-surgeon between October 2000 and January 2014.
Outcome Measures:
Visual analog scale (VAS) back and leg pain, Oswestry Disability Index (ODI) and 36-Item Short-Form Health Survey (SF-36, physical component score [PCS] and mental component score [MCS])
Methods:
Patients were stratified to age groups: 80+years (80’s, n=22), 70-79 (70’s, n=55), 60-69 (60’s, n=54), and <60-years (<60, n=32). Differences between patient age groups and HRQOL outcomes were examined pre-operatively and at 6-, 12- and 24-months and at final follow-up (f/u). Minimum clinically important improvements were set at 25-points for VAS pain, 15-points for ODI and 6.2-points for SF-36 PCS. Non parametric statistical analysis was used with XLSTAT Version 2015.1.01. Significance was set at p<0.05.
Results:
Median times to last f/u were similar for the four age groups: 24 (range:12-57), 24 (12-69), 25 (12-65) & 25 (12-120) months, respectively for the 80’s, 70’s, 60’s & <60 groups. For each of these age groups, the mean pre-op VAS back pain scores (±standard deviation) were: 63±20, 48±27, 54±29 and 54±23. At last f/u the VAS scores improved to 23±25, 14±22, 20±23 and 21±23. The mean pre-op ODI scores were 45.0±15.3, 39.3±18.0, 44.2±15.2 and 43.1±13.7 and at last f/u: 22.0±12.9, 18.2±18.0, 17.3±19.9 & 15.8±16.4. 80% of patients in the 80’s group achieved a clinically important improvement in ODI, compared with 66%, 80% and 73% of patients in the 70’s, 60’s and <60 groups. There were no significant differences between age groups in mean VAS or ODI change scores. For SF-36 PCS, pre-op scores for the 4 groups were: 29.7±9.3, 31.3±9.5, 28.9±8.1 & 32.5±8.7 and at last f/u: 36.4±10.5, 41.7±11.6, 42.4±11.9 & 44.2±11.5. The mean SF-36PCS change score for the 80’s group (6.3±10.8) was less than that observed for the 60’s & <60 groups (13.5±11.1 & 11.9±9.6, p=0.03).
Conclusions:
While undertaking major surgery in elderly patients should always be approached with caution, the current study appears to show that improvements in certain Health-Related Quality-Of-Life outcome measures (back pain and ODI) were not adversely affected by advancing age in patients undergoing lumbar fusion surgery for the single level degenerative pathology examined. The poorer SF-36 PCS scores observed at f/u in older age groups may, at least in part, reflect normal age-related patterns.
