Adult Spinal Deformity Surgery: Complications and Outcomes in Patients over Age 60

Methods: 40 patients who were 60 years of age or older underwent a thoracic/lumbar arthrodesis procedure consisting of 5 levels or more. Diagnosis included degenerative scoliosis(17), fixed sagittal imbalance(13), adult presentation of idiopathic scoliosis(8), ankylosing spondylitis(1), and neurofibromatosis(1). Pre-operative comorbidities, operative and post-operative complications were recorded.

Results: There were 33 females and 7 males with an average age of 66 years (range, 60-85). The average follow-up was 62 months(range 24-224). 31(77%) of patients had at least one comorbidity. 24 (60%) patients had at least one prior spinal surgery. 18(45%) underwent both an anterior and posterior arthrodesis. An average of 9 levels(range 5-15) were fused in each case. The average total surgical time( including combined surgery) was 603 minutes(10 hours). Average total EBL was 1942cc(range 300-5500cc), and an average of 5 units of blood were transfused. The total average hospital days were 14(range 6-43). The overall complication rate was 37%. 12 patients( 27%) had at least one minor complication and 7(16%) had at least one major complication. 14 (27%) of patients required additional surgery most commonly for pseudarthrosis and implant complications. Oswestry Disability Index scores improved by a mean of 23 from a pre-op of 49 to a post-op of 27 (p<0 .0001).

Conclusions: Adult spinal deformity surgery in older patients is demanding and requires a significant amount of surgical time, hospitalization and blood transfusion requirements. The overall complication rate is 37%, the major complication rate 16% and the re-operation rate 27%. Patients reported significant improvement in function with long term follow-up. Patient selection in this high risk group is extremely important.

Hibbs Award Nominee for Best Clinical Paper