Patients with spinal deformity over the age of 75: a retrospective analysis of operative versus non-operative management.

Abstract

The goal of the present study was to compare the outcomes of operative and non-operative patients with adult spinal deformity (ASD) over 75years of age. A retrospective review of a multicenter prospective adult spinal deformity database was conducted examining patients with ASD over the age of 75years. Demographics, comorbidities, operation-related variables, complications, radiographs, and Health-related quality of life (HRQOL) measures collected included Oswestry Disability Index, Short Form-36, and Scoliosis Research Society-22 preoperatively, and at 1 and 2years later. Minimum clinically important difference (MCID) was calculated and also compared. 27 patients (12 operative, 15 non-operative) were studied. There were no significant differences (p>0.05) between operative and non-operative patients for age, body mass-index, and comorbidities, but operative patients had worse baseline HRQOL than non-operative patients. Operative patients had a significant improvement in radiographic parameters in 2-year HRQOL, whereas non-operative patients did not (p>0.05). Operative patients were significantly more likely to reach MCID (range 41.7-81.8 vs. 0-33.3%, p<0.05). In the surgical group, 9 (75%) patients had at least 1 complication (24 total complications). In the largest series to date comparing operative and non-operative management of adult spinal deformity in elderly patients greater than 75years of age, reconstructive surgery provides significant improvements in pain and disability over a 2-year period. Furthermore, operative patients were more likely to reach MCID than non-operative patients. When counseling elderly patients with ASD, such data may be helpful in the decision-making process regarding treatment.