Health-Related Quality of Life after Posterolateral Lumbar Arthrodesis in Patients Seventy-Five Years of Age and Older

Abstract

Retrospective cohort analysis of prospectively collected data. The purpose of this study is to report health-related quality of life (HRQOL) outcomes in patients 75 years of age and older who underwent one- to two-level instrumented posterolateral lumbar arthrodesis. HRQOL measures are increasingly used to measure clinical success after spinal surgery. There is limited data available to guide the clinician caring for the growing geriatric population with degenerative lumbar spine conditions. From a database of prospectively collected HRQOL measures in patients undergoing instrumented lumbar arthrodesis, we identified 35 patients 75 years of age and older who underwent one- or two-level instrumented posterolateral lumbar arthrodesis who had complete preoperative and 2-year postoperative data. HRQOL measures included the Oswestry Disability Index (ODI), Short Form-36 Physical Component Score (PCS) and Mental Component Score (MCS), and back and leg pain numerical rating scales. Paired sample t tests were used to compare preoperative and 2-year postoperative scores. The percentage of patients reaching previously established thresholds for Minimum Clinically Important Difference (MCID) and Substantial Clinical Benefit (SCB) were calculated. There were 11 men and 24 women with a mean age of 78.3 years (range 75-85). Diagnoses included stenosis (20), spondylolisthesis (12), instability (1), disc pathology (1), and scoliosis (1). Twelve patients (34%) had complications, 8 (23%) major and 4 (11%) minor. There was a statistically significant improvement in all of the HRQOL measures from preoperative to 2-years postoperative. Sixty percent (21 of 35) of the patients reached the MCID threshold for ODI, PCS, and leg pain, whereas 83% (29 of 35) reached the MCID for back pain. More than half of the patients reached the SCB threshold for leg pain (19 of 35, 54%), back pain (21 of 35, 60%), ODI (19 of 35, 54%), and PCS (21 of 35, 60%). Properly selected patients 75 years of age and older can achieve substantial clinical improvements, based on patient reported HRQOL measures, 2 years after one- and two-level instrumented posterolateral lumbar arthrodesis.