Abstract
PurposeDegenerative spondylolisthesis (DS) is a debilitating condition that carries a high economic burden. As the global population ages, the number of patients over 80 years old demanding spinal fusion is constantly rising. Therefore, neurosurgeons often face the important decision as to whether to perform surgery or not in this age group, commonly perceived at high risk for complications.MethodsSix hundred seventy-eight elder patients, who underwent posterolateral lumbar fusion for DS (performed in three different centers) from 2012 to 2020, were screened for medical, early and late surgical complications and for the presence of potential preoperative risk factors. Patients were divided in three categories based on their age: (1) 60–69 years, (2) 70–79 years, (3) 80 and over. Multiple logistic regression was used to determine the predictive power of age and of other risk factors (i.e., ASA score; BMI; sex; presence or absence of insulin-dependent and -independent diabetes, use of anticoagulants, use of antiaggregants and osteoporosis) for the development of postoperative complications.ResultsIn univariate analysis, age was significantly and positively correlated with medical complications. However, when controls for other risk factors were added in the regressions, age never reached significance, with the only noticeable exception of cerebrovascular accidents. ASA score and BMI were the two risk factors that significantly correlated with the higher numbers of complication rates (especially medical).ConclusionPatients of different age but with comparable preoperative risk factors share similar postoperative morbidity rates. When considering octogenarians for lumbar arthrodesis, the importance of biological age overrides that of chronological.
Highlights
Degenerative spondylolisthesis (DS) is a pathological condition caused by degenerative alterations in the spine in which one vertebral body is displaced over the one below, and it is commonly associated with spinal stenosis [2, 33]
Inclusion criteria were 1 or 2 levels of spondylolisthesis, evidence of Schizas grade C or D spinal stenosis on MRI, neurogenic claudication, absence of degenerative scoliosis > 5°, and vertebral instability documented by a dynamic orthostatic X-rays radiography
Eight of the predictor variables were categorical while Body mass index (BMI) was the only continuous one
Summary
Degenerative spondylolisthesis (DS) is a pathological condition caused by degenerative alterations in the spine in which one vertebral body is displaced over the one below, and it is commonly associated with spinal stenosis [2, 33].The first clinical case of spondylolisthesis has been described in Europe in 1782 by a Belgian obstetricianThis article is part of the Topical Collection on Spine Degenerative.Extended author information available on the last page of the article (Herbiniaux) who first named this phenomenon “spondyloptosis,” and depicted this pathological condition as a mechanical hinderance to delivery which reduced the diameter of the pelvic inlet [12]. Degenerative spondylolisthesis (DS) is a pathological condition caused by degenerative alterations in the spine in which one vertebral body is displaced over the one below, and it is commonly associated with spinal stenosis [2, 33]. This article is part of the Topical Collection on Spine Degenerative. Extended author information available on the last page of the article (Herbiniaux) who first named this phenomenon “spondyloptosis,” and depicted this pathological condition as a mechanical hinderance to delivery which reduced the diameter of the pelvic inlet [12]. DS results primary from arthritis of the facet joints that thwarts motion of the joint and leads to stress and instability. This, in turn, provokes lessening of the ligamentum flavum, degenerative instability, and consequent anterior displacement of the vertebrae [9, 27]
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