Surgical Management of Lumbar Spinal Stenosis in Patients Over 80 : Is There an Increased Risk ?

Abstract Introduction:Management of lumbar spinal stenosis (LSS) represents the first cause of spinal surgery for the elderly and will increase with the aging population. Although the surgery improves quality of life, the procedure involves anaesthetic and operative risks. The aim of this study was to assess whether the postoperative complications rate was higher for elderly patients and to find confounding factors.Material and MethodsWe conducted a retrospective study including all LSS surgeries between 2012 and 2020 at the University Hospital of Caen. We compared two populations opposing patients aged over 80 with others. The primary endpoint was the occurrence of a severe complication (SC). Minor complications were the secondary endpoint. Comorbidities, history of lumbar spine surgery and surgical characteristics were recorded.Results996 patients undergoing surgery for degenerative LSS were identified. Patients over 80 were significantly affected by additional comorbidities: hypertension, heart diseases, higher age-adjusted comorbidity Charlson score, ASA score and use of anticoagulants. Knee-chest position was preferred for younger patients. Older patients underwent a more extensive decompression and had more incidental durotomies. 5.2% of patients presented SC. Age over 80 did not appear to be a significant risk factor for SC, but minor complications increased. Multivariate analysis showed that heart diseases, history of laminectomy, AA-CCI, and accidental durotomies were independent risk factors for SC.ConclusionSurgical management for lumbar spinal stenosis is not associated to a higher rate of severe complications for patients over 80 years of age. However, preoperative risk factors should be investigated to warn the elderly patients that the complications risk is increased although an optimal preparation is the way to avoid them.

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Gait analysis in the elderly patients with lumbar spinal stenosis

International Orthopaedics ◽

10.1007/s00264-020-04935-w ◽

2021 ◽

Vol 45 (3) ◽

pp. 673-679

Author(s):

Yong-Gang Li ◽

Li-Ping Li ◽

Zhen-Jiang Li ◽

Hui Li ◽

Yuan Li ◽

...

Keyword(s):

Elderly Patients ◽

Gait Analysis ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

The Elderly ◽

Lumbar Spinal

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Linical efficacy of percutaneous endoscopic lumbar discectomy for the treatment of lumbar spinal stenosis in elderly patients: a retrospective study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01968-0 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Hua Li ◽

Yufu Ou ◽

Furong Xie ◽

Weiguo Liang ◽

Gang Tian ◽

...

Keyword(s):

Elderly Patients ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Lumbar Discectomy ◽

Lumbar Spine Surgery ◽

Decompression Surgery ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Pain Scores ◽

Endoscopic Lumbar Discectomy ◽

Lumbar Spinal

Abstract Background Although percutaneous endoscopic lumbar discectomy (PELD) is increasingly being used to treat lumbar degenerative disease, the treatment of elderly patients with lumbar spinal stenosis (LSS) involves considerable uncertainty. The purpose of this study was to evaluate the safety and effectiveness of PELD for the treatment of LSS in elderly patients aged 65 years or older. Methods In this retrospective review, 136 patients aged 65 years or older who underwent PELD to treat LSS were evaluated. The patients were divided into two groups, group A (ages 65–74) and group B (age ≥ 75), and perioperative data were analyzed. The Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and MacNab classification were used to evaluate postoperative clinical efficacy. Results All patients successfully underwent the operation with satisfactory treatment outcomes. Compared to preoperative scores, the self-reported scores or pain while performing daily activities were significantly improved in both treatment groups (P < 0.05). No statistically significant between-group differences were observed in operation time, intraoperative blood loss, postoperative bed rest, and postoperative hospital stay (P > 0.05). The overall postoperative complication rate was similar between the two groups. Moreover, no statistically significant differences in VAS-back pain scores, VAS-leg pain scores, JOA scores, and MacNab classification were found between the groups at the 3-month and 1.5-year follow-up examinations (P > 0.05). Conclusion PELD is safe and effective for the treatment of LSS in elderly patients. Age is not a contraindication for decompressive lumbar spine surgery. PELD has advantages such as reduced trauma, fewer anesthesia-related complications, and a fast postoperative recovery. Elderly patients should be considered good candidates for lumbar decompression surgery using minimally invasive techniques.

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Lumbar spinal stenosis in elderly patients: is a unilateral microsurgical approach sufficient for decompression?

Journal of Neurosurgery Spine ◽

10.3171/2010.10.spine09708 ◽

2011 ◽

Vol 14 (3) ◽

pp. 305-312 ◽

Cited By ~ 19

Author(s):

Matthias Hubert Morgalla ◽

Nicola Noak ◽

Martin Merkle ◽

Marcos Soares Tatagiba

Keyword(s):

Back Pain ◽

Elderly Patients ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Elderly Population ◽

The Elderly ◽

Pain Questionnaire ◽

Pain Disability ◽

Disability Scale ◽

Lumbar Spinal

Object For the treatment of lumbar spinal stenosis, less invasive procedures, which preserve maximal bony and ligamentous structures, have been recommended to reduce associated morbidity. The authors examined the outcome after decompression of spinal stenosis in the elderly by comparing 3 different surgical approaches. Their focus was whether a unilateral microsurgical decompression provided sufficient outcomes in the elderly population. Methods The authors investigated 108 elderly patients (age ≥ 60 years) with lumbar spinal stenosis (mean age 71 years [range 60–93 years]) who underwent surgery between 2004 and June 2006 at the authors' institution. Three different modes of decompression were analyzed in this study: a unilateral partial hemilaminectomy, a hemilaminectomy, and a laminectomy. The outcome was assessed 12 months postoperatively using the Quebec Back Pain Disability Scale and the Hannover Functional Back Pain Questionnaire. Results The authors performed a unilateral partial hemilaminectomy in 53 patients (49%). Patients who underwent unilateral partial hemilaminectomies achieved favorable results of at least 80% as assessed using the Quebec Back Pain Disability Scale and Hannover Functional Back Pain Questionnaire. Hemilaminectomies were performed in 45 patients (41.7%), and laminectomies were performed in 10 patients (9.3%). However, there was no statistically significant difference between the various techniques regarding the postoperative results (p < 0.05). Conclusions Laminectomies did not show any advantage when compared with unilateral transmedian approaches. A unilateral partial hemilaminectomy combined with a transmedian decompression sufficiently treated the stenosis. This method seemed advantageous in minimizing the procedure and associated morbidity in this elderly population. Further investigations with long-term results (> 5 years) are still necessary.

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Risk factors for 90-day reoperation and readmission after lumbar surgery for lumbar spinal stenosis

Journal of Neurosurgery Spine ◽

10.3171/2019.1.spine18878 ◽

2019 ◽

Vol 31 (1) ◽

pp. 20-26 ◽

Cited By ~ 4

Author(s):

Haariss Ilyas ◽

Joshua L. Golubovsky ◽

Jingxiao Chen ◽

Robert D. Winkelman ◽

Thomas E. Mroz ◽

...

Keyword(s):

Risk Factors ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Readmission Rate ◽

Significant Risk ◽

Complication Rates ◽

Duration Of Surgery ◽

History Of ◽

Male Sex ◽

Lumbar Spinal

OBJECTIVEThe objective of this study was to evaluate the incidence and risk factors for 90-day readmission and reoperation after elective surgery for lumbar spinal stenosis (LSS).METHODSThe authors performed a retrospective consecutive cohort analysis of patients undergoing posterior lumbar decompression with or without fusion for LSS with claudication from January 2014 through December 2015.RESULTSData were collected on 1592 consecutive patients. The mean age at surgery was 67.4 ± 10.1 years and 45% of patients were female. The 90-day reoperation rate was 4.7%, and 69.3% of the reoperations occurred within the first 30 days. The 90-day readmission rate was 7.2%. Multivariable analysis showed that postoperative development of a surgical site infection (SSI; odds ratio [OR] 14.09, 95% confidence interval [CI] 7.86–25.18), acute kidney injury (AKI; OR 6.76, 95% CI 2.39–19.57), and urinary tract infection (UTI; OR 3.96, 95% CI 2.43–6.37), as well as a history of congestive heart failure (CHF; OR 3.03, 95% CI 1.69–5.28), were significant risk factors for readmission within 90 days. Male sex (OR 0.60, 95% CI 0.38–0.92) was associated with decreased odds for readmission. With regards to reoperation, development of SSI (OR 25.06, 95% CI 13.54–46.51), sepsis (OR 7.63, 95% CI 1.52–40.59), UTI (OR 2.54, 95% CI 1.31–4.76), and increased length of stay (LOS; OR 1.25, 95% CI 1.17–1.33) were found to be significant risk factors. A subsequent analysis found that morbid obesity (OR 6.99), history of coronary artery disease (OR 2.263), increased duration of surgery (OR 1.004), and LOS (OR 1.07) were significant risk factors for developing an SSI.CONCLUSIONSOverall, this study found rates of 4.7% and 7.2% for reoperation and readmission, respectively, within 90 days: 30.7% of the reoperations and 44.7% of the readmissions occurred beyond the first 30 days. A diagnosis of SSI, AKI, UTI, and history of CHF were significant factors for readmission, while male sex was associated with decreased odds for readmission. A diagnosis of SSI, sepsis, UTI, and increased LOS were found to be significant predictors for reoperation. Understanding 90-day complication rates is imperative because there has been increased discussion and healthcare policy extending the global postoperative window to 90 days. Current literature supports a readmission rate of 3%–9% after spine surgery. However, this literature either is limited to a 30-day window or does not stratify between different types of spine surgeries.

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Linical efficacy of percutaneous endoscopic lumbar discectomy for the treatment of lumbar spinal stenosis in elderly patients: a retrospective study

10.21203/rs.3.rs-37006/v3 ◽

2020 ◽

Author(s):

hua Li ◽

Yufu Ou ◽

Furong Xie ◽

Weiguo Liang ◽

Gang Tian ◽

...

Keyword(s):

Elderly Patients ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Lumbar Discectomy ◽

Lumbar Spine Surgery ◽

Decompression Surgery ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Pain Scores ◽

Endoscopic Lumbar Discectomy ◽

Lumbar Spinal

Abstract Background: Although: percutaneous endoscopic lumbar discectomy (PELD) is increasingly being used to treat lumbar degenerative disease, the treatment of elderly patients with lumbar spinal stenosis (LSS) involves considerable uncertainty. The purpose of this study was to evaluate the safety and effectiveness of PELD for the treatment of LSS in elderly patients aged 65 years or older. Methods: In this retrospective review, 136 patients aged 65 years or older who underwent PELD to treat LSS were evaluated. The patients were divided into two groups, group A (age 65-74) and group B (age ≥ 75), and perioperative data were analyzed. The Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and MacNab classification were used to evaluate postoperative clinical efficacy. Results: All patients successfully underwent the operation with satisfactory treatment outcomes. Compared to preoperative scores, the self-reported scores for pain while performing daily activities were significantly improved in both treatment groups (P<0.05). No statistically significant between-group differences were observed in operation time, intraoperative blood loss, postoperative bed rest, and postoperative hospital stay (P > 0.05). The overall postoperative complication rate was similar between the two groups. Moreover, no statistically significant differences in VAS-back pain scores, VAS-leg pain scores, JOA scores, and MacNab classification were found between the groups at the 3-month and 1.5-year follow-up examinations (P>0.05). Conclusion: PELD is safe and effective for the treatment of LSS in elderly patients. Age is not a contraindication for decompressive lumbar spine surgery. PELD has advantages such as reduced trauma, fewer anesthesia-related complications, and a fast postoperative recovery. Elderly patients should be considered good candidates for lumbar decompression surgery using minimally invasive techniques.

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The Therapeutic Evaluation of Spinal Canal Decompression by Using the TBEIS Technique in the Treatment of Lumbar Spinal Stenosis

BioMed Research International ◽

10.1155/2020/6183027 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Kemin You ◽

Bo Li ◽

Hongze Chang ◽

Yan Zhang ◽

Feng Cai ◽

...

Keyword(s):

Elderly Patients ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Clinical Efficacy ◽

The Elderly ◽

Clinical Effects ◽

Vas Scores ◽

Immediate Surgery ◽

Lumbar Spinal

Objective. To evaluate the clinical efficacy of the percutaneous endoscopic Transforaminal Broad Easy Immediate Surgery (TBEIS) technology in elderly patients with lumbar spinal stenosis (LSS). Methods. From February 2016 to May 2018, 35 elderly patients with LSS were treated with the TBEIS technique. There were 23 males and 12 females, aged from 53 to 72 years with a median age of 63.1 years. Preoperative, 1 day, and 1 and 12 months postoperative visual analogue scale (VAS) scores and Oswestry Disability Index (ODI) were statistically analyzed. The modified MacNab criterion was used to assess the clinical effects. The radiological outcomes were evaluated by X-ray and computed tomography (CT). Results. All of the operations were successful. The operative time ranged from 120 to 170 min with a median time of 148 min. All of the patients were followed up for 12 to 38 months with a median follow-up of 18 months. Preoperative, 1 day, and 1 and 12 months postoperative VAS leg scores were 6.91±0.98, 1.69±0.68, 1.23±0.59, and 0.91±0.61, respectively, and the VAS back scores improved from 4.51±0.82 to 0.66±0.68. The ODI scores were 63.82±7.59, 38.79±6.36, 24.79±3.90, and 11.33±3.92, respectively. Postoperative scores of VAS and ODI were obviously improved (P<0.01). According to the modified MacNab criteria used to evaluate the clinical effects, 11 cases achieved excellent results, 18 cases achieved good results, 4 cases achieved fair results, and 2 cases achieved poor results. There were no neurovascular injury and other complications. Conclusions. Treatment of LSS in the elderly patients by the TBEIS technology has good clinical efficacy, and the technique is safe and minimally invasive.

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Clinical Efficacy of Percutaneous Endoscopic Lumbar Discectomy for the Treatment of Lumbar Spinal Stenosis in Elderly Patients

10.21203/rs.3.rs-37006/v1 ◽

2020 ◽

Author(s):

hua Li ◽

Yufu Ou ◽

Furong Xie ◽

Weiguo Liang ◽

Gang Tian ◽

...

Keyword(s):

Elderly Patients ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Clinical Efficacy ◽

Lumbar Discectomy ◽

Lumbar Spine Surgery ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Pain Scores ◽

Endoscopic Lumbar Discectomy ◽

Lumbar Spinal

Abstract Background: Although: percutaneous endoscopic lumbar discectomy (PELD) is increasingly being used to treat lumbar degenerative disease, the treatment of elderly patients with lumbar spinal stenosis (LSS) involves considerable uncertainty. The purpose of this study was to evaluate the safety and effectiveness of PELD for the treatment of LSSin elderly patients aged 65 years or older. Methods: In this retrospective review, 136 patients aged 65 years or older who underwent PELD to treat LSS were evaluated. The patients were divided into two groups, group A (age 65-74) and group B (age ≥ 75), and perioperative data were analyzed. The Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and MacNab classification were used to evaluate postoperative clinical efficacy. Results: All patients successfully underwent the operation with satisfactory treatment outcomes. Compared to preoperative scores, the self-reported scores or pain while performing daily activities were significantly improved in both treatment groups (P<0.05).No statistically significant between-group differences were observed in operation time, intraoperative blood loss, postoperative bed rest, and postoperative hospital stay (P > 0.05). The overall postoperative complication rate was similar between the two groups.Moreover, no statistically significant differences in VAS-back pain scores, VAS-leg pain scores, JOA scores, and MacNab classification were found between the groups at the 3-month and 1.5-year follow-up examinations (P>0.05).Conclusion: PELD is safe and effective for the treatment of LSS in elderly patients. Age is not a contraindication for decompressive lumbar spine surgery. PELD has advantages such as reduced trauma, fewer anesthesia-related complications, and a fast postoperative recovery.Elderly patients should be considered good candidates for lumbar decompression surgery using minimally invasive techniques.

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