gms | German Medical Science

By virtue of increasing age of the population and development of less invasive surgical procedures, neurosurgeons are increasingly confronted with patients, once deemed too old for elective spinal surgery. Literature is mute in regard to results and complications within this elderly cohort. This retrospective study was performed to evaluate the efficacy, patient benefit and safety of neurosurgical treatment of lumbar spinal stenosis in elderly patients (age≥75 years) in our institution.

We reviewed all surgical procedures for lumbar spinal stenosis at our institution between 01/1993 and 06/2003. Clinical outcome (neurological deficits, level of pain relief, walking distance) was analyzed along with treatment related morbidity and preoperative risk factors.

326 procedures were performed in 286 patients (male: female 132:154). Average age was 79.3 ±3.5 years (range 75-93 years).12 patients underwent two, four patients three and one patient four operations. In six of these cases finally a lumbar fusion was performed. Pathology was circular stenosis with disc, hypertrophic ligament and bone (n=138), stenosis of the lateral recess only (n=95), degenerative spondylolisthesis (n=38) and 15 cases of synovial cysts of the facet joints. The procedures used were laminectomy (n=151), laminotomy (n=50), interlaminar fenestration (n=68) and decompression in conjunction with dorsolateral fusion or PLIF (n=35). In 84 patients surgery was performed in multiple levels, in the other 202 patients only one segment was operated on. Mean hospital stay (12.5 ± 4.8 days) was only 0.6 days longer compared to a similar cohort of younger patients. Major morbidity was acceptable (5,5%) with no procedure related deaths. Mean follow-up was 24.4 ±7.9 months postoperatively in 258 cases. 58.5 % thereof (151 / 258) reported no or minimal discomfort, whereas 5.8 % (12 / 258) did not improve at all. Overall 81.8% (211 / 258) were satisfied postoperatively.

Our data indicate that lumbar decompression and even fusion surgery can be undertaken safely and effectively in a population of high age with acceptable morbidity and good clinical improvement.