Effect of advanced age in subjective surgical outcome of patients undergoing spine surgery.

To the Editor: Spine surgeons are often challenged by the treatment of elderly patients with degenerative spinal disease. We conducted a telephone survey of patients treated in our department to estimate the possible effect of age in surgical outcome.

At our institution, 210 patients who underwent surgery for degenerative lumbar spinal disease were included in our retrospective study. A telephone survey was obtained, including questions such as whether the patients thought there was improvement of their symptoms after surgery, if they were symptom free at the time of the study, if the patients had a smooth postoperative recovery, if the patients were satisfied with the surgery, and if they would recommend the same or similar treatment to another person.

Patients were categorized into two groups. Group A included patients younger than 70 years, and group B included patients 70 years or older. Statistical analysis of variance was used, taking into consideration the time that had elapsed from the last surgical operation and the total number of surgical interventions.

Group A included 171 patients (mean age, 56.0; range, 28 to 69). Group B included 39 patients (mean age, 75.1; (range, 70 to 86). Statistical analysis revealed that the presence of other medical conditions and the preoperative employment status of the patients had no statistically significant influence. We examined the surgical outcomes of the two groups at three different time periods: during the first 6 months, between 6 to 12 months after surgery, and finally, more than 1 year after surgery. No statistically significant difference was observed in patients' perception of postoperative smooth recovery between these groups. Moreover, no statistically significant difference was observed in the percentage of patients in the two groups in regard to their complete satisfaction after surgery. An interesting finding was the significantly higher percentage of patients in group B who were completely satisfied between the third and sixth postoperative months (group A = 55% versus group B = 82%, P = 0.045). No statistically significant difference was found in the percentage of patients who would recommend surgery to another person.

It is widely accepted that there are apparent difficulties in conducting outcome studies, primarily because of the difficulties in proper categorization of patients caused by different types of pathology, extent of surgical intervention, coexistence of other medical illnesses, or presence of other conditions such as secondary gain. Numerous studies have been published regarding the surgical outcome of elderly patients undergoing spinal surgery; most of them seem to favor surgical intervention. (1-3)

Analysis of our data suggested that advanced age is not adversely associated with spinal surgery in appropriately selected patients in terms of subjective patient estimation of surgical outcome. In our study, the elderly patients' satisfaction rate was quite similar to the one of the younger age group (50% in group B, 53% in group A). Our findings are in agreement with the results of previously reported series. (1-3) Moreover, in our study, patients older than 70 years seemed more satisfied than younger patients during the first 6 to 12 months after surgery; however, the rate of complete satisfaction declines with time in both groups. This may reflect either that some of the symptoms recur or that the progression of improvement does not meet their expectations. This level of satisfaction was also reflected by whether or not they recommended a similar surgery to another person. Our results showed no significant difference between the two groups.

Previous operations did not adversely affect the outcome of elderly patients in group B with the same number of surgical interventions. There was a decline, however, in both age groups in the rate of satisfaction with one or more previous surgical procedures. Although the results did not reach statistical significance, it seemed that overall, older patients were more satisfied than the younger patients after the first operation.

In our study, elderly patients who underwent surgery for degenerative lumbar spine disease had subjective surgical outcome comparable with younger patients. Further multi-institutional prospective studies are necessary to define guidelines that could help spinal surgeons and patients in decision making.

References

1. Ragab AA, Fye MA, Bohlman HH. Surgery of the lumbar spine for spinal stenosis in 118 patients 70 years of age or older. Spine 2003;28:348-353.

2. Vitaz TW, Raque GH, Shield CB, et al. Surgical treatment of lumbar spinal stenosis in patients older than 75 years of age. J Neurosurg 1999;91(suppl 2):181-185.

3. Kalbarczyl A, Lukes A, Seiler RW. Surgical treatment of lumbar spinal stenosis in the elderly. Acta Neurochir (Wien) 1998;140:637-641.

Vassilios Dimopoulos, MD

Kostas Fountas, MD, PHD

Mozaffar Kassam, MD

Carlos Feltes, MD

Robert Vogel, MD

Joe Sam Robinson, MD, FACS 

Arthur Grigorian, MD

Department of Neurosurgery 

Medical Center of Central Georgia 

Mercer University School of Medicine

Macon, GA

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