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. 2020 Apr;10(2):153-159.
doi: 10.1177/2192568219849393. Epub 2019 May 19.

Outcomes and Quality of Life Improvement After Multilevel Spinal Fusion in Elderly Patients

John M Ibrahim  1 , Paramjit Singh  1 , Daniel Beckerman  1 , Serena S Hu  2 , Bobby Tay  1 , Vedat Deviren  1 , Shane Burch  1 , Sigurd H Berven  1
Affiliations

Outcomes and Quality of Life Improvement After Multilevel Spinal Fusion in Elderly Patients

John M Ibrahim et al. Global Spine J. 2020 Apr.

Abstract

Study design: Retrospective case series.

Objectives: Both the rate and complexity of spine surgeries in elderly patients has increased. This study reports the outcomes of multilevel spine fusion in elderly patients and provides evidence on the appropriateness of complex surgery in elderly patients.

Methods: We identified 101 patients older than70 years who had ≥5 levels of fusion. Demographic, medical, and surgical data, and change between preoperative and >500 days postoperative health survey scores were collected. Health surveys were visual analogue scale (VAS), EuroQoL 5 Dimensions (EQ-5D), Oswestry Disability Index (ODI), Scoliosis Research Society questionnaire (SRS-30), and Short Form health survey (SF-12) (physical composite score [PCS] and mental composite score [MCS]). Minimal clinically important differences (MCIDs) were defined for each survey.

Results: Complications included dural tears (19%), intensive care unit admission (48%), revision surgery within 2 to 5 years (24%), and death within 2 to 5 years (16%). The percentage of patients who reported an improvement in health-related quality of life (HRQOL) of at least an MCID was: VAS Back 69%; EQ-5D 41%; ODI 58%; SRS-30 45%; SF-12 PCS 44%; and SF-12 MCS 48%. Improvement after a primary surgery, as compared with a revision, was on average 13 points higher in ODI (P = .007). Patients who developed a surgical complication averaged an improvement 11 points lower on ODI (P = .042). Patients were more likely to find improvement in their health if they had a lower American Society of Anesthesiologists or Charlson Comorbidity Index score or a higher metabolic equivalent score.

Conclusions: In multilevel surgery in patients older than 70 years, complications are common, and on average 77% of patients attain some improvement, with 51% reaching an MCID. Physiological status is a stronger predictor of outcomes than chronological age.

Keywords: deformity; elderly; fusion; outcome; predictor; quality of life.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Berven reports personal fees from Medtronic, personal fees from Stryker, personal fees from Medicrea, personal fees from GreenSun Medical, outside the submitted work. Dr Burch reports grants and other from Medtronic, outside the submitted work. Dr Deviren reports grants and personal fees from NuVasive, personal fees from Biomet, personal fees from Seaspine, personal fees from Pfizer, personal fees from Medicrea, personal fees from Alphatec, grants from AOSpine, grants from Globus, outside the submitted work. Dr Tay reports personal fees from Biomet, personal fees from Lumetra, grants from NuVasive, grants from AOSPine, grants from Globus, personal fees from Stryker, personal fees from synthes, outside the submitted work. Mr Beckerman, Dr Hu, Mr Ibrahim, and Dr Singh have nothing to disclose.

Figures

Figure 1.
Figure 1.
Eligibility and cohort selection.
Figure 2.
Figure 2.
Change between preoperative and 2-year postoperative quality of life. Percentages of patients who improved at least an MCID (in gray), who had slight improvement (in orange), and who were worse (in blue) at 2-years postoperatively are displayed.
See this image and copyright information in PMC

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