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Effectiveness of Surgery for Lumbar Stenosis and Degenerative Spondy in the Octogenarian Population: Analysis of SPORT data (JBJS 2015)

Screenshot-2015-05-20-00.12.34-e1432095302195-73x98 Effectiveness of Surgery for Lumbar Stenosis and Degenerative Spondy in the Octogenarian Population: Analysis of SPORT data (JBJS 2015) Journal Club Spine | JC


Background: People are living longer, older population numbers are increasing and both stenosis and spondy are common it people over 60 yrs old. Can be treated with both operative and non-op means.

PurposeDetermine whether surgery is an effective option for the tx of stenosis of the lumbar spine and degenerative spondy in octogenarian population.

Materials/Methods: Patients in the SPORTS database – 13 centers, have lumbar stenosis +/- spondy.

Inclusion: neurogenic claudication or radicular leg pain, stenosis on cross section imaging, symptoms persisted for at least 12 wks, physician confirmation that they are surgical candidate.

Exclusion: Spondylosis and isthmic spondylolisthesis.

2 cohorts – randomized (op vs non-op) and observational (chose tx with physician). Lots of crossover.

Patient reported questionaires @ baseline, 6 wks, 3 months, 6 months, 1 yr, 2 yrs & 4 yrs (several listed on pg 178)

Stats – chi-square test and t-test

Results:
– 105 patients with lumbar stenosis (+/- degen spondy) and at least 80 yo, 1130 younger than 80
– 80+ yo at baseline had higher HTN, heart disease, osteoporosis, and joint problems, lower BMI, depression, and smoking. No difference in the primary or secondary outcomes (questionnaire scores)
– 80+ yo had more multilevel stenosis, severe stenosis and asymmetric motor weakness
– 55% of the 80+ yo underwent surgery (68% decompression alone, 14% unistrument & 18% instrum)
– 66% of the – 80+ yo’s had significantly more multilevel laminectomites
– No difference in intra/post-op complications, reoperations or post-op mortality
– Primary outcome measures improved significantly in 80+ year old’s undergoing surgery, same goes for secondary outcomes

Discussion: As elderly population number increase, it is important to find interventions that are effective in improving the QOL for elderly patients with spinal disorders. This study shows that operative intervention for those with lumbar spinal stenosis +/- degen spondy offers substantial benefit over non-op tx. Treatment effect is larger for those younger than 80.

Limitations:
– Differing number of patients undergoing arthrodesis in old/young groups, may have had higher complications rate in older group if they had undergone arthrodesis more frequently
– SPORT not specifically designed to detect differences in outcomes according to age, relatively low number of 80+ yo’s undergoing arthrodesis

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