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Eur Spine J. 2016 Aug;25(8):2433-41. doi: 10.1007/s00586-015-3759-7. Epub 2015 Feb 6.

Patients with spinal deformity over the age of 75: a retrospective analysis of operative versus non-operative management.

Author information

1
Department of Neurosurgery, The Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 5-185, Baltimore, MD, 21287, USA. dsciubb1@jhmi.edu.
2
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
3
Department of Neurosurgery, The Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 5-185, Baltimore, MD, 21287, USA.
4
Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA.
5
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
6
Department of Orthopaedic Surgery, University of California, Davis, CA, USA.
7
San Diego Center for Spinal Disorders, La Jolla, CA, USA.
8
Neurosurgical Medical Clinic, San Diego, CA, USA.
9
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
10
Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA.
11
Rocky Mountain Hospital for Children, Denver, CO, USA.
12
Department of Orthopaedic Surgery, Oregon Health and Science University, Portland, OR, USA.
13
Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.

Abstract

PURPOSE:

The goal of the present study was to compare the outcomes of operative and non-operative patients with adult spinal deformity (ASD) over 75 years of age.

METHODS:

A retrospective review of a multicenter prospective adult spinal deformity database was conducted examining patients with ASD over the age of 75 years. Demographics, comorbidities, operation-related variables, complications, radiographs, and Health-related quality of life (HRQOL) measures collected included Oswestry Disability Index, Short Form-36, and Scoliosis Research Society-22 preoperatively, and at 1 and 2 years later. Minimum clinically important difference (MCID) was calculated and also compared.

RESULTS:

27 patients (12 operative, 15 non-operative) were studied. There were no significant differences (p > 0.05) between operative and non-operative patients for age, body mass-index, and comorbidities, but operative patients had worse baseline HRQOL than non-operative patients. Operative patients had a significant improvement in radiographic parameters in 2-year HRQOL, whereas non-operative patients did not (p > 0.05). Operative patients were significantly more likely to reach MCID (range 41.7-81.8 vs. 0-33.3 %, p < 0.05). In the surgical group, 9 (75 %) patients had at least 1 complication (24 total complications).

CONCLUSIONS:

In the largest series to date comparing operative and non-operative management of adult spinal deformity in elderly patients greater than 75 years of age, reconstructive surgery provides significant improvements in pain and disability over a 2-year period. Furthermore, operative patients were more likely to reach MCID than non-operative patients. When counseling elderly patients with ASD, such data may be helpful in the decision-making process regarding treatment.

KEYWORDS:

75 years; Adult spinal deformity; Complications; Elderly; HRQOL; MCID; Non-operative; Scoliosis

PMID:
25657104
DOI:
10.1007/s00586-015-3759-7
[Indexed for MEDLINE]

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