Lumbar Surgery in the Elderly Provides Significant Health Benefit in the US Health Care System

BACKGROUND Lumbar spine degenerative pathologies are prevalent in the United States. The health benefit of spine surgery in the elderly has been questioned. OBJECTIVE To compare effectiveness, morbidity, and quality of care associated with surgical management of degenerative lumbar spinal disorders in elderly vs nonelderly patients. METHODS The National Neurosurgery Quality and Outcomes Database registry prospectively collects measures of surgical safety and patient-reported outcomes for 1 year after surgery. All lumbar surgery cases were queried to compare the elderly surgical population (70 years of age and older) and associated outcomes with patients younger than 70 years of age. RESULTS A total of 4370 lumbar spine surgeries were enrolled in National Neurosurgery Quality and Outcomes Database with 1-year follow-up; 1020 (23%) were elderly patients. The elderly had an increased incidence of heart disease, osteoporosis, high-risk anesthesia grade (American Society of Anesthesiologists grade 3/4), more than 3 level surgery, ambulation assist device use, unemployment, female sex, white race, and stenosis as a diagnosis. The elderly patients had a lower body mass index, incidence of anxiety/depression, liability/workers' compensation claims, and disc herniation as a diagnosis. Length of hospitalization and postdischarge inpatient rehabilitation/nursing facility was significantly greater in the elderly. The incidence of surgical complications and 90-day hospital readmission were similar. Significant and equivalent improvements at 1 year in pain, disability, and quality of life were reported by both elderly and nonelderly patients overall and for each unique spine diagnosis. CONCLUSION For all ages, lumbar spine surgery resulted in significant improvement in pain, disability, and quality of life. Elderly patients experienced equivalent and significant health benefit in all measured health domains without an increased rate of surgical complications or hospital readmissions. Elective lumbar spine surgery in the elderly provides significant gains in health status, justifying its continued use in this growing population.