gms | German Medical Science

Objective: Geriatric health care has become a worldwide concern and the increasing incidence of patients aged 80 or older (80+) with spine disease is the result of an increasing demographic aging of the general population. We therefore evaluate the most relevant diagnoses of these 80+ patients with regard to neurological outcome and comorbidities and try to find criteria which 80+ patients may benefit from a spinal intervention.

Method: All patients aged 80 or older in the period from January 2013 to May 2014 with a spinal disease admitted to our neurosurgical department were included in the study. Age, gender, diagnosis and co-morbidities, neurostatus at admission, type of operative procedure and complications as well as neurostatus at discharge were assessed. Numeric data are given as mean values ± SD.

Results: 57 patients (men 19, female 38) with a mean age of 82,9 (range 80-94) were included in the study. 33 patients (58%) presented 2 or more relevant medical disorders. In 22 cases the most frequent diagnosis was lumbar spinal stenosis with 60% in 1 level-, 18% in 2 level- and 9% in 3 level-decompressive therapies. 20 cases of degenerative spine disease (e.g. facet joint syndrome) with conservative treatment by infiltration therapy were registered. In 9 cases a trauma with spinal fractures (67% odontoid fracture, 1% lumbar spine fracture and 2% cervical spine fracture) was reason for hospital admission. Patients with cervical spinal stenosis (3%), disc herniation (3%) and spinal tumors (3%) were extremely rare. Major postoperative complications were seen in 3 cases. In the trauma patients group one patient suffered on pneumonia. By two patients operated on lumbar spinal stenosis one patient presented a multisystem organ failure and the other showed signs of acute renal failure plus infection. By analyzing postoperative pain and outcome 91% of the aged 80 or older patients reported pain reduction after surgical- or conservative intervention and in 93% a discharge at home was possible.

Conclusions: The question whether surgery is the treatment of choice in aged 80 or older spine patients or this age group would benefit more from conservative therapy could not clearly answered. However the consideration of patients' co-morbidities remains relevant for the treatment decision. With careful patient selection and clear surgical indication even patients aged 80 or older can profit from spinal surgery.