Outcome of Spinal Surgery in Patients above the Age of 90 Years

Introduction: Increased life expectancy has led to indications for spine surgery in elderly patients above the age of 90 years, but data to counsel these patients on the risks and outcome is lacking.

Aim: We reviewed our experience to shed light on the implications and prognosis of spine surgeries in this age group.

Materials and Methods: The files of all patients who were 90 years or older at the time of spinal surgery between 2006 and 2016 were retrospectively analyzed to retrieve indication for surgery, extent of surgery, complications, functional outcome, and survival.

Results: Sixty-nine patients were included, corresponding to a total of 73 surgeries. Mean age was 91.5 1.5 (range, 90–97). Fifty-nine percent were female. About 54.8% of treated cases had degenerative and 35.6% traumatic pathologies. Eighty-four percent were operated electively and 16% after emergent hospital admission. Thirty-three percent of elective and 58% of emergent surgeries were stabilized. The overall complication rate was 65.8% (54.1% in the elective surgery group [ELSG] and 125% in the emergency surgery group [EMSG] [p = 0.010]). An analysis of predictive factors showed that stabilization (p = 0.006) and emergency setting of surgeries (p = 0.032) are significant factors for the occurrence of any complication. Six weeks after surgery, 80% of patients report symptomatic improvement, 16.9% report that the symptoms are the same and 3.1% report symptomatic worsening. Analyzing individual mortality, we found out that 56.9% of the patients of the overall cohort reached normal median life expectancy of their age and gender group. In the ELSG, 60.5% of the patients reached normal median life expectancy, whereas only 37.5% in the EMSG reached normal median life expectancy. Forty percent of the patients of the EMSG versus 0% of the ELSG died in the first 3 months after surgery (p = 0.016). In the nonstabilized group, 69% of the patients, whereas only 40.9% of the stabilized group, reached normal median life expectancy of their age and gender group.

Conclusion: Elective spinal surgery in patients over 90 years is not reducing life expectancy. Moreover, it seems to have a good functional outcome for well-selected patients. Emergency spinal surgery and stabilization surgery in this age group are associated with a high complication rate and a higher mortality.