Introduction: Spinal stenosis is primarily a disease of the older population. Return to functional status is generally achieved with decompressive surgery, but there is an increasing number of patients who have co-existent overt or occult spinal instability. In such patients, decompression alone not only does not relieve the symptoms, but often makes them worse. Instrumented reconstruction is frequently not performed even if indicated for a fear that this patient population could not tolerate such extensive surgery. In our institution, we have adopted an aggressive approach and performed stabilization if indicated regardless of age.
Methods: We have analyzed the surgical results of 85 patients ranging in age from 32 to 87 years old. We have retrospectively compared the results of decompression with instrumented fusion including pedicle screws fixation and the transforaminal lumbar interbody fusion (TLIF) in 85 patients divided into two age groups, <64 and = 65. The study had two arms. The first arm which is the subject of this communication was to assess the safety of the surgery. In the second arm we compared the results. We compared minor and major complications as defined by Reindel et al., the length of surgery, length of hospital stay and transfusion requirements.
Results: There was statistically no significant difference in the rate of complications between these two groups (Table 1).
Conclusions: We conclude that with modern anesthesia, advanced age alone, even with the common comorbidities of that population is not a contraindication to extensive spine reconstruction where indicated (Table 2).
Patient Care: Elderly patients with evidence of spinal instability and multiple comorbidities, including age, have historically been treated by non-operative or less aggressive procedures. We demonstrate that patients >65 yo with multiple comorbidities can safely undergo complex spinal reconstruction.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) discuss and compare the complications of instrumented spinal fusion in the elderly and younger populations 2) describe the importance of evaluating for both overt and occult spinal instability 3) Identify patients that would be appropriately treated and benefit from instrumented spinal fusion regardless of age.