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Revision spinal fusion in patients older than 75: is it worth the risks?
Michael S Chang1, Yu-Hui H Chang, Jan Revella
1*Sonoran Spine Center; Phoenix, AZ; and †Division of Health Sciences Research Mayo Clinic, Scottsdale, AZ.
Study Design:
Retrospective clinical study of a prospective database.
Objective:
This study aims to determine whether revision spinal fusion surgery is worthwhile in patients older than 75 from a risk-benefit perspective.
Summary Of Background Data:
The benefits of spinal fusion in patients older than 65 is well documented. However, the clinical benefit to patients older than 75 of revision surgery, which often yields worse outcomes with higher complication rates, is uncertain.
Methods:
Ninety-nine consecutive patients older than 75 with minimum 2-year follow-up underwent spinal fusion as either a primary (n = 58) or revision (n = 41) operation. Diagnoses were spondylolisthesis (n = 43), scoliosis (n = 28), kyphosis (n = 5), and other degenerative spinal disorders (n = 26). Outcomes were obtained prospectively by visual analogue scale (VAS) and Oswestry Disability Index (ODI) at preoperative, 1-year, 2-year, and latest follow-up.
Results:
Revision patients had significantly worse scores compared with primary patients at all time intervals, for both VAS (preoperative: 6.4 vs. 5.8, 1 yr: 3.6 vs. 2.4, 2 yr: 4.7 vs. 2.5) and ODI (preoperative: 52.2 vs. 44.1, 1 yr: 37.3 vs. 25.6, 2 yr: 47.0 vs. 25.0). Both groups improved significantly at 1 year postoperatively. At 2 years, the results of revision surgery deteriorated (ΔVAS: -1.7, ΔODI: -5.2), whereas the benefits of primary procedures were maintained (ΔVAS: -3.3, ΔODI: -19.1). Complications were generally greater in the revision group and included revision surgery (8[19.5%] vs. 7[12.1%]), nonunion (2[4.9%] vs. 3[5.2%]), adjacent level fracture (4[9.8%] vs. 6[10.3%]), infection (6[14.7%] vs. 2[3.4%]), foot drop (0[0.0%] vs. 4[6.9%]), imbalance (4[9.8%] vs. 1[1.7%]), pulmonary failure (1[2.4%] vs. 1[1.7%]), and death (0[0.0%] vs. 1[1.7%]).
Conclusion:
Despite having worse initial ODI and VAS scores, revision patients older than 75 initially benefit as much as patients older than 75 undergoing primary operations. However, at 2 years, revision patients do not have a sustained benefit despite a higher complication rate.
Level Of Evidence:
4.
