gms | German Medical Science

Objective: This paper will examine whether surgery on intra- and extramedullary tumors is associated with higher morbidity in patients of advanced age (over 70 years).

Method: Since 1991 all spinal tumors were entered into a database. Patients were examined preoperatively, postoperatively, and as outpatients after 3 months and yearly thereafter. The results of these examinations were documented with a scoring system. Long-term results were analysed with Kaplan-Meier statistics.

Results: Among 318 patients with intramedullary tumours 23 patients were 70 years or older (7.2%). Among 647 patients with extramedullary tumours, 77 (11.9%) belonged in this age group. 16 patients with intramedullary and 65 patients with extramedullary tumours underwent surgery. Whereas histologies for intramedullary tumours were similar between adult age groups above and below 70 years of age, meningiomas were more common in patients of advanced age among extramedullary tumours. After surgery for extramedullary tumours, elderly patients demonstrated similar rates for complications (14.1% and 13.2%), transient (7.7% and 9.7%), and permanent surgical morbidity (4.6% and 3.6%) compared to adults below age 70. Likewise, recurrence rates after 5 years (22.7% and 24.3%) were similar in both groups. Among patients of advanced age, 67.7% demonstrated a sustained postoperative neurological improvement. For intramedullary tumours, however, treatment results for elderly patients were less favourable. Even though rates for complications (6.3% and 14.1%) were lower and transient surgical morbidities (50.0% and 43.9%) similar compared to adults below 70 years of age, elderly patients required a longer rehabilitation period to regain their preoperative status. Permanent surgical morbidity tended to be higher for patients of advanced age (25.0% and 17.9%). Rates for complete tumour resections and tumour recurrence rates after 5 years were almost identical for elderly patients (22.2% and 20.7%).

Conclusions: For patients of advanced age surgery for extramedullary tumors produces excellent short- and long-term results. Intramedullary tumors are rare in this age group. Rates for transient and permanent surgical morbidity tend to be higher in elderly patients. The major reason for this course appears to be difficulty to overcome deficits of joint position sense. Nevertheless, surgery of intramedullary tumors remains the best option to preserve neurological functions even in advanced age.