Is spinal surgery safe in octogenarians?

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Over the next 50 years, ageing is the most dramatic change projected to occur in the Australian population.1 Together with modern advances in medical management, this will result in an increasing number of octogenarians presenting with degenerative or emergency (tumour, traumatic or infective) conditions that may require spinal surgery. The decision‐making process of spinal surgeons should take into consideration the clinical indications for surgery; the age, general health, physical status, functional independence and survival prognosis of the patient; and the predicted recovery and potential risks and benefits of surgery, as well as the natural history of the condition if left untreated. These considerations are very different in the elective versus the emergency setting.
Older patients generally have more comorbidities and may have different subjective opinions on interventions and outcomes when considering elective spinal surgery, compared with the younger population with similar conditions. Many studies have shown the benefit of elective spinal surgery for symptomatic degenerative conditions, such as lumbar spinal stenosis, after conservative treatment fails.2 Several studies have shown favourable outcomes following spinal surgery in terms of improvement in pain, function and quality of life in the elderly age group of over 70–80 years.3 However, others have observed an increased incidence of postoperative complications with increasing age and comorbidities.8 Certain studies have used physical status scoring systems, such as the American Society of Anesthesiologists (ASA) score and Charlson Comorbidity Index (CCI), and associated these with complications seen postoperatively.2 It remains unclear as to whether or not the risk : benefit ratio is favourable in octogenarian patients undergoing spinal surgery.
Studies investigating emergency spinal surgery in the elderly have usually focussed on odontoid fractures.14 To the best of the authors’ knowledge, no studies exist looking at morbidity and mortality of emergency spinal surgery across other traumatic fractures and other indications (e.g. tumour, infection, progressive myelopathy) in this demographic. Further study in this area is required in order to generate evidence on patient outcomes. Consideration should be given as to whether age alone should be an exclusion factor for spinal surgery. The aim of the present study is to examine the association between comorbidities and extent of surgery with complications following spinal surgery in a cohort of Australian octogenerians treated at a single tertiary referral centre, therefore helping to determine whether spinal surgery can be safely performed in this age group.
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