Daniel M. Sciubba, Justin K. Scheer, Alp Yurter, Justin S. Smith, Virginie Lafage, Eric Klineberg, Munish Gupta, Robert Eastlack, Gregory M. Mundis, Themistocles S. Protopsaltis, Donald Blaskiewicz, Han Jo Kim, Tyler Koski, Khaled Kebaish, Christopher I. Shaffrey, Shay Bess, Robert A. Hart, Frank Schwab, Christopher P. Ames


July 2016, Volume 25, Issue 8, pp 2433 - 2441 Original Article Read Full Article 10.1007/s00586-015-3759-7

First Online: 06 February 2015

Purpose

The goal of the present study was to compare the outcomes of operative and non-operative patients with adult spinal deformity (ASD) over 75 years of age.

Methods

A retrospective review of a multicenter prospective adult spinal deformity database was conducted examining patients with ASD over the age of 75 years. Demographics, comorbidities, operation-related variables, complications, radiographs, and Health-related quality of life (HRQOL) measures collected included Oswestry Disability Index, Short Form-36, and Scoliosis Research Society-22 preoperatively, and at 1 and 2 years later. Minimum clinically important difference (MCID) was calculated and also compared.

Results

27 patients (12 operative, 15 non-operative) were studied. There were no significant differences (p > 0.05) between operative and non-operative patients for age, body mass-index, and comorbidities, but operative patients had worse baseline HRQOL than non-operative patients. Operative patients had a significant improvement in radiographic parameters in 2-year HRQOL, whereas non-operative patients did not (p > 0.05). Operative patients were significantly more likely to reach MCID (range 41.7–81.8 vs. 0–33.3 %, p < 0.05). In the surgical group, 9 (75 %) patients had at least 1 complication (24 total complications).

Conclusions

In the largest series to date comparing operative and non-operative management of adult spinal deformity in elderly patients greater than 75 years of age, reconstructive surgery provides significant improvements in pain and disability over a 2-year period. Furthermore, operative patients were more likely to reach MCID than non-operative patients. When counseling elderly patients with ASD, such data may be helpful in the decision-making process regarding treatment.


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