Aging & Longevity
Is surgery a viable option for
patients age 80 plus with acute spinal conditions?
Study found no difference in
complications, mortality when compared to younger patients
Feb. 5, 2015 - As the number of Americans
age 80 and older continues to rise, so does the percentage of patients
with acute spinal conditions. A new study found significant benefit from
surgical treatment for
lumbar spinal stenosis with and without
degenerative spondylolisthesis - debilitating
spinal conditions causing leg and back pain, numbness and weakness - and
no higher overall complication rate and no higher mortality for patients
age 80 and older when compared to patients younger than age 80.
Between 2000 and 2010 the U.S. population age 80
and older increased 22 percent to 11.2 million, and approximately 47
percent of Americans age 60 and older have spinal stenosis, a narrowing
of the spinal canal due to the wear and tear associated with aging.
In this study, researchers reviewed Spine Patient
Outcomes Research Trial (SPORT) data for 105 patients, age 80 and older,
and 1,130 patients younger than age 80 with lumbar stenosis alone or
combined with degenerative spondylolisthesis.
Patient clinical characteristics, including age,
sex, ethnicity, college and work status, body mass index (BMI), smoking,
comorbidities, level of back and leg pain, self-assessment of general
health and treatment preference, were reviewed at baseline. Levels of
pain, assessment of general health, complications, the need for revision
surgery, and mortality were measured postoperatively for up to four
The study appears in the
Journal of Bone & Joint Surgery (JBJS).
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Fifty-eight (55.2 percent) of the patients who were
at least 80 years old underwent surgery – either a
spinal fusion (arthrodesis) or a laminectomy, which is the removal
of bone spurs, bone and ligaments that may be pressing on the spinal
nerves— as did 749 (66.3 percent) of the patients under age 80. At
baseline, patients age 80 and older had a higher prevalence of
hypertension, heart disease, osteoporosis and joint problems, but a
lower BMI, and a lower prevalence of depression and smoking. Among the
● Averaged over a four-year follow-up period,
operatively treated patients at least 80 years of age, had significantly
greater improvement in all primary and secondary outcome measures
compared with patients at least 80 years of age who received nonsurgical
● Both groups—under and over age 80—had comparable
rates of complications during and after surgery, reoperations and
● Patients age 80 and older had a significantly
greater proportion of multi-level lumbar laminectomies (those involving
three or more levels of the spine) compared with younger patients (60
percent versus 32 percent).
● The benefits of surgery in patients at least 80
years of age were similar to those in younger patients, except for the
outcome measures of pain and physical function, which were higher in the
under age 80 group.
"This study demonstrates that surgery for the
treatment of lumbar stenosis and degenerative spondylolisthesis provides
significant benefit compared to nonoperative treatment in those patients
over the age of 80," said lead study author
Jeffrey A. Rihn, MD, an orthopaedic surgeon at the Rothman
Institute and associate professor at Thomas
Jefferson University Hospital in
"Patients in this age group had significant
improvement in their function after surgery and complication rates
comparable to the younger demographic. Based on the results of this
study, surgery should be considered a viable treatment option for these
lumbar conditions in patients older than age 80. Future studies are
needed to better assess the cost-effectiveness of surgery in this
An analysis of patients treated for lumbar stenosis and degenerative
spondylolisthesis, who were enrolled in the Spine Patient Outcomes
Research Trial (SPORT), was performed. Patients who were at least 80
years of age were compared with those younger than 80. Baseline patient
and clinical characteristics were noted, and the difference in
improvement from baseline between operative and nonoperative treatment
was determined for each group at each follow-up time period up to four
A random individual effect was included to account
for correlation between repeated measurements within individuals, and a
formal interaction time between treatment and age was included for
comparing the treatment effect in subgroups.
lumbar spinal stenosis
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● American Academy of Orthopaedic Surgeons (AAOS) on
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