gms | German Medical Science

Objective: An increasing demographic aging of the general population results in an increasing incidence of patients >80 years with degenerative spine disease. We therefore assessed the benefit of lumbar decompression with regard to neurological outcome, medical conditions and complication rates of patients 85 years or older in a retrospective single center series

Method: 84 pats. (45 f / 39 m, mean age 89.6 yrs, 86–96) who underwent lumbar decompression between 01/2008 and 05/2013 were retrospectively assessed. Age at surgery, neurological status, relevant medical comorbidities and former surgeries at index levels, complications, duration of surgery, length of hospital stay and rate of revision surgeries were recorded.

Results: Surgery was performed for lumbar stenosis (59 pats., 70%), disc herniation (6 pats., 7%) or both (19 pats., 23%). 31/84 received 1-level, 29/84 2-level, 24/84 3-level decompression. 13/84 (16%) pats. had at least one previous surgery at the index level. Mean duration of surgery was 88 ± 37 min (range 22-184). Mean length of hospitalization was 11 ± 6.8 d (3–31). Preoperative neurological deficits were seen in 33% (28). 19 (68%) of them improved, 9 (32%) were unchanged, none deteriorated. New postoperative neurological deficits did not occur. All 18 (21%) intraoperative complications were mild to moderate: 17 durotomies (20%), 1 nerve root affection (1%). 2 pats. needed revision surgeries for CSF leak and epidural hematoma during the same hospital stay. Preoperative 81 pats. (96%) had a mean of 2 (1–6) relevant medical disorders. 8 (10%) postoperative medical complications were reported (1 humerus fracture, 2 pulmonary embolisms, 3 pneumonias, 1 thrombosis, 1 urinary tract infection). In house mortality was 2%; 1 pat. with pneumonia and pulmonary embolism, 1 pat. with cardiac failure and pulmonary edema. Most of the patients (80/84, 95%) benefited from surgery at discharge from hospital. 63% (59) pats. were satisfied during the last follow-up (6.7 ± 13 months; 0–65). 23% (19) were suffering from chronic back pain treated mostly conservatively. 14% (11) still had Sciatica.

Conclusions: In spite of their age the vast majority of octo- and nonagenarians benefited from lumbar decompression surgery. Mild to moderate complications were relatively frequent, whereas severe complications were rare. With thorough patient selection and stringent surgical indications even patients in this very old age group can profit from surgery.