Patient-Rated Outcomes of Lumbar Fusion in Patients with Degenerative Disease of the Lumbar Spine: Does Age Matter?

Marbacher, Serge; Mannion, Anne F; Burkhardt, Jan-Karl; Schär, Ralph T.; Porchet, François; Kleinstück, Frank; Jeszenszky, Dezsö; Fekete, Tamas F; Haschtmann, Daniel (2015). Patient-Rated Outcomes of Lumbar Fusion in Patients with Degenerative Disease of the Lumbar Spine: Does Age Matter? Spine, 41(10), pp. 893-900. Lippincott Williams & Wilkins 10.1097/BRS.0000000000001364

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STUDY DESIGN

Single centre retrospective study of prospectively collected data, nested within the Eurospine Spine Tango data acquisition system.

OBJECTIVE

The aim of this study was to assess the patient-rated outcome and complication rates associated with lumbar fusion procedures in three different age groups.

SUMMARY OF BACKGROUND DATA

There is a general reluctance to consider spinal fusion procedures in elderly patients due to the increased likelihood of complications.

METHODS

Before and at 3, 12, and 24 months after surgery, patients completed the multidimensional Core Outcome Measures Index (COMI). At the 3-, 12-, and 24-month follow-ups they also rated the Global Treatment Outcome (GTO) and their satisfaction with care. Patients were divided into three age groups: younger (≥50y < 65y; n = 317), older (≥65y < 80y; n = 350), and geriatric (≥ 80y; n = 40).

RESULTS

707 consecutive patients were included. The preoperative comorbidity status differed significantly (p < 0.0001) between the age groups, with the highest scores in the geriatric group. Medical complications during surgery were lower in the younger age group (7%) than in the older (13.4%; p = 0.006) and geriatric groups (17.5%; p = 0.007); surgical complications tended to be higher in the elderly group (younger, 6.3%; older, 6.0%; geriatric, 15.0%; p = 0.09). There were no significant group differences (p > 0.05) for the scores on any of the COMI domains, GTO, or patient-rated satisfaction at either 3-, 12-, and 24-months follow-up.

CONCLUSIONS

Despite greater comorbidity and complication rates in geriatric patients, the patient-rated outcome was as good in the elderly as it was in younger age groups up to two years after surgery. These data indicate that geriatric age needs careful consideration of associated risks but is not per se a contraindication for fusion for lumbar degenerative disease.

LEVEL OF EVIDENCE

4.

Interest & Impact

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