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Chan V, Witiw CD, Wilson JRF, Wilson JR, Coyte P, Fehlings MG. Frailty is an important predictor of 30-day morbidity in patients treated for lumbar spondylolisthesis using a posterior surgical approach. Spine J 2022; 22:286-295. [PMID: 34500077 DOI: 10.1016/j.spinee.2021.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Traditionally, a nonoperative approach has been favored for elderly patients with lumbar spondylolisthesis due to a perceived higher risk of morbidity with surgery. However, most studies have used an arbitrary age cut-off to define "elderly" and this research has yielded conflicting results. PURPOSE The purpose of this study was to investigate the impact of frailty on morbidity after surgery for degenerative lumbar spondylolisthesis treated with a posterior approach. STUDY DESIGN A retrospective cohort study was performed. PATIENT SAMPLE The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, with years 2010 to 2018 included in this study. Patients who received posterior lumbar spine decompression with or without single level posterior instrumented fusion for degenerative lumbar spondylolisthesis were included. Patients who received anterior and/or lateral approaches were excluded. OUTCOME MEASURES The primary outcome was Clavien-Dindo grade IV complication. Secondary outcomes were readmission, reoperation, and discharge to location other than home. METHODS Patient demographics and comorbidities were extracted. Logistic regression analysis was performed to investigate the association between outcomes and the Modified Frailty Index-5, adjusting for age, gender, body mass index, smoking status, and surgical procedure performed. A sub-analysis was done to assess the effect of frailty in three different age groups (18-45 years, 46-65 years, and >65 years) for the two surgical cohorts. RESULTS There were 15,658 patients in this study. The mean age was 62.5 years. Approximately 70% of the patients received decompression with fusion. Frailty was significantly associated with an increased risk of major complication, unplanned readmission, reoperation, and non-home discharge. The risk increased with increasing frailty. For patients who received decompression, frailty was associated with a higher risk of readmission and non-home discharge in patients >65 years. For patients who received decompression and fusion, frailty was associated with a higher risk of complications, readmission, and non-home discharge in patients >65 years. CONCLUSIONS Frailty is independently associated with a higher risk of morbidity after posterior surgery in patients with lumbar spondylolisthesis, especially in patients older than 65. These data are of significance to clinicians in planning treatment for these patients.
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Affiliation(s)
- Vivien Chan
- Department of Neurosurgery, University of Alberta, 11400 University Avenue, Edmonton, Alberta T6G 2B7, Canada; Division of Neurosurgery, Department of Surgery, 149 College Street, University of Toronto, Toronto, Ontario M5T 2S8, Canada
| | - Christopher D Witiw
- Division of Neurosurgery, Department of Surgery, 149 College Street, University of Toronto, Toronto, Ontario M5T 2S8, Canada
| | - Jamie R F Wilson
- Division of Neurosurgery, Department of Surgery, 149 College Street, University of Toronto, Toronto, Ontario M5T 2S8, Canada; Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada; Department of Neurosurgery, University of Nebraska Medical Center, 42nd and, Emile Street, Omaha, NE, 68198, USA
| | - Jefferson R Wilson
- Division of Neurosurgery, Department of Surgery, 149 College Street, University of Toronto, Toronto, Ontario M5T 2S8, Canada
| | - Peter Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, 149 College Street, University of Toronto, Toronto, Ontario M5T 2S8, Canada; Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada.
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Goel A, Bhambere S, Shah A, Dandpat S, Vutha R, Rai SKR. Lumbar canal stenosis in "young" - How does it differ from that in "old" - An analysis of 116 surgically treated cases. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:123-128. [PMID: 34194157 PMCID: PMC8214238 DOI: 10.4103/jcvjs.jcvjs_53_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/28/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: Patients treated for lumbar canal stenosis (LCS) were retrospectively analyzed to evaluate the differences in clinical management in those below (Group A) and those above (Group B) the age of 50 years. All patients were treated with the premise that instability is the nodal point of the pathogenesis of LCS and “only-stabilization” is the surgical treatment. Materials and Methods: During the period June 2014 to June 2020, 116 cases were diagnosed to have LCS and surgically treated by the Goel modification of Camille's transarticular screw fixation technique. Results: Twenty-four patients in Group A and six patients in Group B had a history of “significant” injury to the back at the onset of clinical symptoms. The indices suggested that the intensity of symptoms was relatively more severe in Group A than in Group B. Unilateral leg symptoms were more common in Group A (68%) than in Group B (31.8%). Neurological motor deficits were more common in Group A (28%) than in Group B (12%) patients. Spinal segments surgically treated in Group A ranged from 1 to 4 (average 2 levels) and in Group B it ranged from 2 to 5 (average 3 levels). During the follow-up period that ranged from 6 to 72 months (average 37 months), 100% of patients had varying degrees of relief from symptoms. Conclusions: LCS is confined to a lesser number of spinal segments in the Group A patients. The symptoms were radicular in nature and relatively severe in Group A than in Group B patients.
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Affiliation(s)
- Atul Goel
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Mumbai, Maharashtra, India.,Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Sagar Bhambere
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Mumbai, Maharashtra, India
| | - Abhidha Shah
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Mumbai, Maharashtra, India
| | - Saswat Dandpat
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Mumbai, Maharashtra, India
| | - Ravikiran Vutha
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Mumbai, Maharashtra, India
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Abstract
STUDY DESIGN A retrospective subgroup analysis of a prospective observational study was carried out. SUMMARY OF BACKGROUND DATA Patients' baseline characteristics may influence the clinical outcomes after minimally invasive lumbar interbody fusion (MILIF). OBJECTIVE This study aimed to investigate the influence of patient's age and body mass index (BMI) on the clinical outcomes of MILIF for degenerative lumbar disorder. MATERIALS AND METHODS A total of 252 patients underwent MILIF. The clinical outcomes, including time to first ambulation, time to postsurgical recovery, back/leg pain in visual analog scale, Oswestry Disability Index, and EuroQol-5 Dimension, were collected at baseline, 4 weeks, 6, and 12 months. Patients were subgrouped by age (50 y and below: N=102; 51-64 y: N=102; 65 y and above: N=48) and BMI (≤25.0: N=79; 25.1-29.9: N=104; ≥30.0: N=69). Data from baseline to 12 months were compared for all clinical outcomes within age/BMI subgroups. Adverse events (AEs) and serious adverse events (SAEs) were summarized by age and BMI subgroups. RESULTS All age and BMI subgroups showed significant improvements in clinical outcomes at 12 months compared with the baseline. The median time to first ambulation was similar for all subgroups (age groups: P=0.8707; BMI: P=0.1013); older people show a trend of having longer time to postsurgical recovery (age groups: P=0.0662; BMI: P=0.1591). Oswestry Disability Index, back, and leg pain visual analog scale, and EuroQol-5 Dimension were similar in all subgroups at every timepoint. A total of 50 AEs (N=39) were reported, 9 of which were SAEs; 3 AEs and 1 SAE were considered to be related to surgical procedure. No differences were observed in safety by age groups and BMI groups. CONCLUSION MILIF appears to be safe and effective, independent of age or weight in the treatment of degenerative lumbar disorder. LEVEL OF EVIDENCE Level II.
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Endler P, Ekman P, Hellström F, Möller H, Gerdhem P. Minor effect of loss to follow-up on outcome interpretation in the Swedish spine register. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:213-220. [DOI: 10.1007/s00586-019-06181-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/11/2019] [Accepted: 10/03/2019] [Indexed: 01/11/2023]
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Nayak NR, Stephen JH, Piazza MA, Obayemi AA, Stein SC, Malhotra NR. Quality of Life in Patients Undergoing Spine Surgery: Systematic Review and Meta-Analysis. Global Spine J 2019; 9:67-76. [PMID: 30775211 PMCID: PMC6362549 DOI: 10.1177/2192568217701104] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Meta-analysis. OBJECTIVE Despite the increasing importance of tracking clinical outcomes using valid patient-reported outcome measures, most providers do not routinely obtain baseline preoperative health-related quality of life (HRQoL) data in patients undergoing spine surgery, precluding objective outcomes analysis in individual practices. We conducted a meta-analysis of pre- and postoperative HRQoL data obtained from the most commonly published instruments to use as reference values. METHODS We searched PubMed, EMBASE, and an institutional registry for studies reporting EQ-5D, SF-6D, and Short Form-36 Physical Component Summary scores in patients undergoing surgery for degenerative cervical and lumbar spinal conditions published between 2000 and 2014. Observational data was pooled meta-analytically using an inverse variance-weighted, random-effects model, and statistical comparisons were performed. RESULTS Ninety-nine articles were included in the final analysis. Baseline HRQoL scores varied by diagnosis for each of the 3 instruments. On average, postoperative HRQoL scores significantly improved following surgical intervention for each diagnosis using each instrument. There were statistically significant differences in baseline utility values between the EQ-5D and SF-6D instruments for all lumbar diagnoses. CONCLUSIONS The pooled HRQoL values presented in this study may be used by practitioners who would otherwise be precluded from quantifying their surgical outcomes due to a lack of baseline data. The results highlight differences in HRQoL between different degenerative spinal diagnoses, as well as the discrepancy between 2 common utility-based instruments. These findings emphasize the need to be cognizant of the specific instruments used when comparing the results of outcome studies.
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Affiliation(s)
- Nikhil R. Nayak
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - James H. Stephen
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Sherman C. Stein
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Neil R. Malhotra
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Musculoskeletal Injuries and Regenerative Medicine in the Elderly Patient. Phys Med Rehabil Clin N Am 2017; 28:777-794. [DOI: 10.1016/j.pmr.2017.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Lin T, Meng Y, Li T, Jiang H, Gao R, Zhou X. Predictors of Postoperative Recovery Based on Health-Related Quality of Life in Patients after Degenerative Lumbar Scoliosis Surgery. World Neurosurg 2017; 109:e539-e545. [PMID: 29038078 DOI: 10.1016/j.wneu.2017.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 10/02/2017] [Accepted: 10/04/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the factors associated with the recovery process of elderly patients after degenerative lumbar scoliosis surgery. METHODS A total of 213 elderly patients who had undergone surgical treatment for degenerative lumbar scoliosis from 2011 to 2015 were included retrospectively in this study. Clinical data and demographics were collected for logistic regression analysis. RESULTS Among 213 eligible patients, 77 (38.5%) were classified as being in the excellent group, 70 (35%) as showing improvement, 24 (12%) as showing no change, and 29 (14.5%) as having deteriorated. At baseline, patients differed significantly from matched normative data in all Scoliosis Research Society domains. Larger differences from normative values were found for pain and activity domains. After surgery, each domain improved significantly. In the multivariate logistic regression, age 60-70 years (odds ratio [OR], 2.431; 95% confidence interval [CI], 1.143-5.174), and American Society of Anesthesiologists grade <3 (OR, 2.987; 95% CI, 1.519-5.874) may be predictive factors for a satisfying recovery, whereas presence of complications (OR, 0.342; 95% CI, 0.153-0.765), fusion to the sacrum (OR, 0.200; 95% CI, 0.076-0.523), and more osteotomies (OR, 0.360; 95% CI, 0.132-0.985) have negative effects on the recovery process. CONCLUSIONS The factors that affect postoperative recovery in elderly patients with degenerative lumbar scoliosis are age, American Society of Anesthesiologists grade, distal fusion level, presence of complications, and number of osteotomies.
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Affiliation(s)
- Tao Lin
- Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's Republic of China
| | - Yichen Meng
- Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's Republic of China
| | - Tangbo Li
- Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's Republic of China
| | - Heng Jiang
- Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's Republic of China
| | - Rui Gao
- Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's Republic of China.
| | - Xuhui Zhou
- Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's Republic of China.
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Bouloussa H, Alzakri A, Ghailane S, Vergari C, Mazas S, Vital JM, Coudert P, Gille O. Is it safe to perform lumbar spine surgery on patients over eighty five? INTERNATIONAL ORTHOPAEDICS 2017; 41:2091-2096. [PMID: 28748381 DOI: 10.1007/s00264-017-3555-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/23/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the safety and tolerance of lumbar spine surgery in patients over 85. MATERIALS AND METHODS Patients over 85 years of age with LSS who underwent decompression surgery with or without fusion between February 2011 and July 2014 were included. Comorbidities, autonomy (Activities of Daily Life and Braden scales), surgical parameters and complications (Clavien-Dindo classification) were collected. A telephone survey was performed to assess survival and patients' satisfaction at last follow-up. RESULTS Mean follow-up was 27.4 ± 7.6 months (range, 18-65). Mean age was 87.5 ± 2.7 years (range, 85-97). Mean ADLs and Braden scores were, respectively, 4.3 ± 1.2 and 20.2 ± 1.4. Fifteen patients had associated spondylolisthesis. Nineteen minor complications (grade I and II, 38.7%), five moderate complications (grade III, 10.2%) and six major complications (grade IV and V, 12.2%) occurred. The perioperative mortality rate was 0.02%. At last follow-up, 41 patients were very satisfied (83.7%), five patients were satisfied (10.2%) and three patients were not satisfied (6.1%). Fusion did not affect the incidence of complications (p = 0.3) nor the average number of complications per patient (p = 0.2). CONCLUSION Advanced age should not be a contraindication to lumbar spine surgery provided careful preoperative selection is performed. This study reported a high satisfaction rate and a low mortality rate at the price of a high number of complications, most of which being minor.
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Affiliation(s)
- Houssam Bouloussa
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France.
| | - Abdulmajeed Alzakri
- Orthopaedic Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Soufiane Ghailane
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Claudio Vergari
- University of Exeter, School of Physics and Astronomy, Exeter, UK
| | - Simon Mazas
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Jean-Marc Vital
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Pierre Coudert
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Olivier Gille
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
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Carreon LY, Glassman SD, Shaffrey CI, Fehlings MG, Dahl B, Ames CP, Matsuyama Y, Qiu Y, Mehdian H, Cheung KMC, Schwab FJ, Pellisé F, Kebaish KM, Lenke LG. Predictors of Health-Related Quality-of-Life After Complex Adult Spinal Deformity Surgery: A Scoli-RISK-1 Secondary Analysis. Spine Deform 2017; 5:139-144. [PMID: 28259266 DOI: 10.1016/j.jspd.2016.11.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/24/2016] [Accepted: 11/11/2016] [Indexed: 01/22/2023]
Abstract
STUDY DESIGN Longitudinal cohort. OBJECTIVES To identify variables that predict 2-year Short Form-36 Physical Composite Summary Score (SF-36PCS) and the Scoliosis Research Society-22R (SRS22-R) Total score after surgery for complex adult spinal deformity. SUMMARY OF BACKGROUND DATA Increasingly, treatment effectiveness is assessed by the extent to which the procedure improves a patient's health-related quality of life (HRQOL). This is especially true in patients with complex adult spinal deformity. METHODS The data set from the Scoli-Risk-1 study was queried for patients with complete 2-year SF-36 and SRS-22R. Regression analysis was performed to determine predictors of 2-year SF-36PCS and SRS-22R Total scores. Factors included were sex, age, smoking status, body mass index, American Society of Anesthesiologists (ASA) grade, Lower Extremity Motor Score improvement, indication for surgery, preoperative and 2-year maximum coronal Cobb angles, number of prior spine surgeries, number of three-column osteotomies, number of surgical levels, number of surgical stages, lowest instrumented level, presence and type of neurologic complication, and number of reported serious adverse events. RESULTS Of 272 cases enrolled, 206 (76%) cases were included in this analysis, 143 (69%) females, and mean age of 57.69 years. Factors that were significantly associated with of 2-year SF-36PCS were age (p < .001), ASA grade (p < .001), maximum preoperative Cobb angle (p = .007), number of three-column osteotomies (p = .049) and type of neurologic complication (p = .068). Factors predictive of 2-year SRS-22R Total scores were maximum preoperative Cobb angle (p = .001) and the number of serious adverse events (p = .071). CONCLUSIONS Factors predictive of lower 2-year HRQOLs after surgery for complex adult spinal deformity were older age, higher ASA grade, larger preoperative Cobb angle, larger numbers of three-column osteotomies, and the occurrence of both neurologic and nonneurologic complications. Most of these factors are beyond the control of surgeons. Still, surgeons should medically optimize a patient prior to surgery to minimize the risk of complications and offer the best chance of improving a patient's quality of life. LEVEL OF EVIDENCE Level II. Prospective cohort.
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Affiliation(s)
- Leah Y Carreon
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA
| | - Steven D Glassman
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia, PO Box 800212, Charlottesville, VA 22908, USA
| | - Michael G Fehlings
- Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst St. Suite 4WW-449, Toronto, ON M5T2S8, Canada
| | - Benny Dahl
- Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, California, 400 Parnassus Ave, San Francisco, CA 94143
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu-city, Shizuoka 431-3192, Japan
| | - Yong Qiu
- Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing 210008, China
| | - Hossein Mehdian
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Derby Rd, Nottingham NG7 2UH, United Kingdom
| | - Kenneth M C Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China
| | - Frank J Schwab
- Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10021, USA
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Vall d'Hebron, Traumatology Building 2nd Floor, Passeig Vall Hebron 119-129, Barcelona 08035, Spain
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224, USA
| | - Lawrence G Lenke
- The Spine Hospital, Columbia University Medical Center, 5141 Broadway, 3 Field West, New York, NY 10034, USA
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Strömqvist F, Strömqvist B, Jönsson B, Karlsson MK. The outcome of lumbar disc herniation surgery is worse in old adults than in young adults. Acta Orthop 2016; 87:516-21. [PMID: 27391663 PMCID: PMC5016912 DOI: 10.1080/17453674.2016.1205173] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The outcome of surgical treatment of lumbar disc herniation (LDH) has been thoroughly evaluated in middle-aged patients, but less so in elderly patients. Patients and methods - With validated patient-reported outcome measures (PROMs) and using SweSpine (the national Swedish Spine Surgery Register), we analyzed the preoperative clinical status of LDH patients and the 1-year postoperative outcome of LDH surgery performed over the period 2000-2012. We included 1,250 elderly patients (≥ 65 years of age) and 12,840 young and middle-aged patients (aged 20-64). Results - Generally speaking, elderly patients were referred for LDH surgery with worse PROM scores than young and middle-aged patients, they improved less by surgery, they experienced more complications, they had inferior 1-year postoperative PROM scores, and they were less satisfied with the outcome (with all differences being statistically significant). Interpretation - Elderly patients appear to have a worse postoperative outcome after LDH surgery than young and middle-aged patients, they are referred to surgery with inferior clinical status, and they improve less after the surgery.
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Benoist M. The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the "medical" articles in the European Spine Journal, 2014. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:12-21. [PMID: 25480113 DOI: 10.1007/s00586-014-3703-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Michel Benoist
- Service de Chirurgie Orthopédique, Département de Rhumatologie, Hôpital Beaujon, 100 Boulevard Général Leclerc, 92118, Clichy, France,
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