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Importance of physiological age in determining indications for adult spinal deformity surgery in patients over 75 years of age: a propensity score matching analysis

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Abstract

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.

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Acknowledgements

The authors wish to thank Ms. Ayaka Shimazaki, Ms. Yukako Hashimoto, and Ms. Maya Ueda for their assistance with data reduction and administration.

Funding

The authors received no specific funding for this work.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan

    Shizumasa Murata, Shunji Tsutsui, Hiroshi Hashizume, Hiroshi Iwasaki, Masanari Takami, Keiji Nagata, Kimihide Murakami, Ryo Taiji, Takuhei Kozaki & Hiroshi Yamada

  2. Spine Center, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Tochigi, Nikko City, 321-2593, Japan

    Akihito Minamide

  3. Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan

    Yukihiro Nakagawa

Authors
  1. Shizumasa Murata
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  3. Hiroshi Hashizume
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Contributions

Conception and design: S.T., Acquisition of data: K.M., R. T., and T. K., Analysis and interpretation of data: K.N. and H. H., Drafting the article: S. M., Critically revising the article: A.M., Y. N., and H.I., Review of the manuscript: all authors., Approval of the final version of the manuscript: all authors. Statistical analysis: H. H. and K. N., Administrative/technical/material support: H. Y., S. T., and M. T., Study supervision: H.Y.

Corresponding author

Correspondence to Shunji Tsutsui.

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Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethics approval

All patient procedures performed in this study were in accordance with the ethical standards of the research ethics committee of our university (with ethical approval number: 2943) and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all participants.

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Murata, S., Tsutsui, S., Hashizume, H. et al. Importance of physiological age in determining indications for adult spinal deformity surgery in patients over 75 years of age: a propensity score matching analysis. Eur Spine J 31, 3060–3068 (2022). https://doi.org/10.1007/s00586-022-07379-5

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