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  • Elderly Patients Have Worse EQ-5D Outcomes After Spondylolisthesis Surgery Than Young Patients, Yet They Are Satisfied With Surgery

    Final Number:

    Andrew Chan; Erica Bisson; Mohamad Bydon; Steven Glassman; Kevin Foley; Eric Potts; Christopher Shaffrey; Mark Shaffrey; Domagoj Coric; Michael Wang; John Knightly; Paul Park; Kai-Ming Fu; Jonathan Slotkin; Anthony Asher; Michael Virk; Panagiotis Kerezoudis; Silky Chotai; Anthony M. DiGiorgio; Catherine Miller; Regis Haid; Praveen Mummaneni

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: A recent randomized clinical trial assessing outcomes following surgery for lumbar spinal stenosis and spondylolisthesis excluded patients who were older than 80 years. This study assesses outcomes for patients age>80 years following surgery for degenerative lumbar spondylolisthesis.

    Methods: This was a retrospective analysis of a prospective registry. 808 patients underwent surgery for grade 1 degenerative lumbar spondylolisthesis at twelve high-enrolling sites. Elderly patients were identified as age>80 years. Baseline and surgical variables were collected. Numeric rating scale (NRS) back pain, NRS leg pain, Oswestry Disability Index (ODI), EuroQoL-5D (EQ-5D), and the North American Spine Society (NASS) Satisfaction Questionnaire were collected at baseline and 12 months.

    Results: Thirty six (4.5%) patients were elderly (range 80-95 years). Elderly patients had lower mean BMI (28.1±4.9 vs. 30.7±6.4, p=0.01), had a higher proportion of osteoporosis (16.7 vs. 6.5%, p=0.04) and were less independently ambulatory at baseline (75.0 vs. 88.0%, p=0.04). Elderly patients received fewer fusion procedures (41.7 vs. 75.8%, p<0.001). There was no difference in satisfaction (elderly 83.3 vs. 83.7% NASS 1/2; p=0.85) and reoperation rate (elderly 8.3 vs. 4.9%, p=0.60) at 12 months. At baseline, the elderly cohort had less NRS back pain (5.6±3.1 vs. 6.9±2.6, p=0.02) and higher EQ-5D (0.62±0.19 vs. 0.54±0.24, p=0.04). At 12 months, both the elderly and the control cohort improved significantly with respect to mean baseline values for NRS back and leg pain, ODI, and EQ-5D (p<0.01 for all comparisons). In multivariate analysis, elderly status predicted inferior 12-month EQ5D change scores (OR 0.92, 95% CI 0.86-0.99, p=0.03) but was not predictive of NRS back and leg pain, and ODI change scores (all p>0.05).

    Conclusions: In adjusted analysis, age>80 years was associated with inferior improvements in EQ-5D at 12 months following lumbar spondylolisthesis surgery. However, the elderly had similar satisfaction, pain, and disability as the younger patients.

    Patient Care: Outcomes for the elderly are poorly defined following surgery for degenerative lumbar spondylolisthesis. This study provides prospective evidence that the elderly (age > 80 years) had similar satisfaction, pain, and disability as younger patients despite inferior improvement in EQ-5D.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the outcomes for patients greater than 80 years of age undergoing lumbar spondylolisthesis surgery (patients who were excluded in a recent large randomized clinical trial) 2) Understand that elderly patients had similar outcomes for satisfaction, pain, and disability 12 months following surgery despite inferior improvement in EQ-5D


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