Purpose

Physiologically, people age at different rates, which leads to a discrepancy between physiological and chronological age. Physiological age should be a priority when considering the indications for adult spinal deformity (ASD) surgery. The primary objective of this study was to determine the characteristics of the postoperative course, surgical outcomes, and complication rates to extend the healthy life expectancy of older ASD patients (≥ 75 years). The secondary objective was to clarify the importance of physiological age in the surgical treatment of older ASD patients, considering frailty.

Methods

A retrospective review of 109 consecutive patients aged ≥ 65 years with symptomatic ASD who underwent a corrective long fusion with lateral interbody fusion from the lower thoracic spine to the pelvis from 2015 to 2019 was conducted. Patients were classified into two groups according to age (group Y [65–74 years], group O [≥ 75 years]) and further divided into four groups according to the ASD-frailty index score (Y-F, Y-NF, O-F, and O-NF groups). To account for potential risk factors for perioperative course characteristics, complication rates, and surgical outcomes, patients from the database were subjected to propensity score matching based on sex, BMI, and preoperative sagittal spinal alignment (C7 sagittal vertical axis, pelvic incidence-lumbar lordosis, and pelvic tilt). Clinical outcomes were evaluated 2 years postoperatively, using three patient-reported outcome measures of health-related quality of life: the Oswestry Disability Index, Scoliosis Research Society questionnaire (SRS-22), and Short Form 36 (SF-36). Additionally, the postoperative time-to-first ambulation, as well as minor, major, and mechanical complications, were evaluated.

Results

In the comparison between Y and O groups, patients in group O were at a higher risk of minor complications (delirium and urinary tract infection). In contrast, other surgical outcomes of group O were comparable to those of group Y, except for SRS-22 (satisfaction) and time to ambulation after surgery, with better outcomes in Group O. Patients in the O-NF group had better postoperative outcomes (time to ambulation after surgery, SRS-22 (function, self-image, satisfaction), SF-36 [PCS]) than those in the Y-F group.

Conclusions

Older age warrants monitoring of minor complications in the postoperative management of patients. However, the outcomes of ASD surgery depended more on frailty than on chronological age. Older ASD patients without frailty might tolerate corrective surgery and have satisfactory outcomes when minimally invasive techniques are used. Physiological age is more important than chronological age when determining the indications for surgery in older patients with ASD.

中文翻译：

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生理年龄在确定 75 岁以上患者成人脊柱畸形手术适应症中的重要性：倾向评分匹配分析

目的

在生理上，人们以不同的速度衰老，这导致生理年龄和实际年龄之间存在差异。在考虑成人脊柱畸形 (ASD) 手术的适应症时，应优先考虑生理年龄。本研究的主要目的是确定术后过程、手术结果和并发症发生率的特征，以延长老年 ASD 患者（≥ 75 岁）的健康预期寿命。次要目标是阐明生理年龄在老年 ASD 患者手术治疗中的重要性，考虑到身体虚弱。

方法

对 2015 年至 2019 年 109 名年龄≥65 岁的症状性 ASD 患者进行了一项回顾性研究，这些患者接受了从下胸椎到骨盆的外侧椎体间融合矫正性长融合术。根据年龄将患者分为两组（Y 组 [65-74 岁]，O 组 [≥ 75 岁]），并根据 ASD-虚弱指数评分（YF、Y-NF、OF、和 O-NF 组）。为了考虑围手术期病程特征、并发症发生率和手术结果的潜在风险因素，数据库中的患者根据性别、BMI 和术前矢状脊柱排列（C7 矢状垂直轴、骨盆发生率-腰椎前凸）进行倾向评分匹配和骨盆倾斜）。术后 2 年评估临床结果，使用三种患者报告的健康相关生活质量结果测量：Oswestry 残疾指数、脊柱侧弯研究协会问卷 (SRS-22) 和简表 36 (SF-36)。此外，还评估了术后首次下床活动的时间，以及轻微、主要和机械并发症。

结果

在Y组和O组的比较中，O组患者发生轻微并发症（谵妄和尿路感染）的风险更高。相比之下，O 组的其他手术结果与 Y 组相当，除了 SRS-22（满意度）和术后下床时间，O 组的结果更好。O-NF 组患者的术后结果更好（手术后下地活动时间，SRS-22（功能，自我形象，满意度），SF-36 [PCS]）比 YF 组。

结论

年龄较大需要监测患者术后管理中的轻微并发症。然而，ASD 手术的结果更多地取决于身体虚弱而不是实际年龄。没有虚弱的老年 ASD 患者可能会耐受矫正手术，并在使用微创技术时获得令人满意的结果。在确定老年 ASD 患者的手术指征时，生理年龄比实际年龄更重要。