Lumbar Spine Surgery in the Elderly

STUDY DESIGN: Diagnosis, postoperative complications, and surgical results in patients over 70 years old who underwent surgery for lumbar nerve root compression of a degenerative origin were evaluated in a prospective, consecutive study. SUMMARY OF BACKGROUND DATA: Of the 50 patients investigated, 43 suffered from central spinal stenosis, four from disc herniation, and three from lateral spinal stenosis. METHODS: All patients were investigated preoperatively and at 4, 12, and 24 months postoperatively. A number of subjective and objective variables were investigated and registered in a computer-coded protocol. Data gathered included intraoperative and postoperative complications, relevant diagnosis, and surgical results. Surgical procedures consisted of decompression with a facet-preserving technique in spinal stenosis and conventional open disc excision for disc herniation. Complications were classified as general (anesthetic, cardiopulmonary, and thromboembolic) and surgical. Patients' opinions on pain relief were assessed with a 4-grade scale. RESULTS: No anesthetic, cardiopulmonary, or thromboembolic complications were seen. Three surgical complications occurred: 1) a patient with spondylitis, 2) a patient with dural leakage with spontaneous recovery, and 3) a patient with postoperative cauda equina syndrome that resulted from peridural hematoma. During follow-up, two patients died from unrelated diseases and cerebrovascular lesions developed in two patients. Among the remaining 46 patients, 37 had improved by the 2-year follow-up and nine were unchanged. No patient deteriorated after the operation. CONCLUSION: Degenerative disorders of the lumbar spine in patients over 70 year old can be treated with no anesthetic complications and with 2-year results on par with those of decompressive surgery in younger patients.