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Effectiveness of Surgery for Lumbar Stenosis and Degenerative Spondylolisthesis in the Octogenarian Population: Analysis of the Spine Patient Outcomes Research Trial (SPORT) Data

Rihn, Jeffrey A. MD; Hilibrand, Alan S. MD; Zhao, Wenyan PhD; Lurie, Jon D. MD, MS; Vaccaro, Alexander R. MD; Albert, Todd J. MD; Weinstein, James DO, MS

Journal of Bone & Joint Surgery - American Volume: 4 February 2015 - Volume 97 - Issue 3 - p 177–185
doi: 10.2106/JBJS.N.00313
Scientific Articles
Disclosures

Background: The purpose of this study was to determine whether surgery is an effective option for the treatment of stenosis of the lumbar spine and degenerative spondylolisthesis in the octogenarian population.

Methods: An as-treated analysis of patients with lumbar stenosis and degenerative spondylolisthesis enrolled in the Spine Patient Outcomes Research Trial (SPORT) was performed. Patients who were at least eighty years of age (n = 105) were compared with those younger than eighty years (n = 1130). Baseline patient and clinical characteristics were noted, and the difference in improvement from baseline between operative and nonoperative treatment was determined for each group at each follow-up time period up to four years.

Results: There were no significant baseline differences in the primary or secondary patient-reported clinical outcome measures between the two patient age groups. Patients at least eighty years of age had higher prevalences of multilevel stenosis, severe stenosis, and asymmetric motor weakness. Patients at least eighty years of age also had higher prevalences of hypertension, heart disease, osteoporosis, and joint problems at baseline, but they had a lower body mass index and lower prevalences of depression and smoking. Fifty-eight of the 105 patients at least eighty years of age and 749 of the 1130 younger patients underwent operative management. There were no differences in the rates of intraoperative or postoperative complications, reoperation, or postoperative mortality between the older and younger groups. Averaged over a four-year follow-up period, operatively treated patients at least eighty years of age had significantly greater improvement in all primary and secondary outcome measures compared with nonoperatively treated patients. The treatment effects in patients at least eighty years of age were similar to those in younger patients for all primary and secondary measures except the SF-36 (Short Form-36) bodily pain domain and the percentage who self-rated their progress as a major improvement, in both of which the treatment effect was significantly smaller.

Conclusions: Operative treatment of lumbar stenosis and degenerative spondylolisthesis offered a significant benefit over nonoperative treatment in patients at least eighty years of age (p < 0.05). There were no significant increases in the complication and mortality rates following surgery in this patient population compared with younger patients (p > 0.05).

Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

1The Rothman Institute at Thomas Jefferson University, 952 Chestnut Street, Philadelphia, PA 19107-4216. E-mail address for J.A. Rihn: jrhino16@yahoo.com

2Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755

3Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756

Copyright 2015 by The Journal of Bone and Joint Surgery, Incorporated
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