World Neurosurg. 2019 Oct 16. pii: S1878-8750(19)32655-5. doi: 10.1016/j.wneu.2019.10.040.
von Glinski A1, Elia C2, Ansari D3, Yilmaz E4, Takayanagi A5, Norvell DC6, Pierre CA3, Abdul-Jabbar A3, Chapman JR7, Oskouian RJ3.
Background
Advancements in modern medicine have led to longer life expectancy. Literature on spinopelvic fixation in elderly patients is limited. We investigated morbidity and mortality in octogenarians who underwent spinopelvic fixation.
Methods
A retrospective chart review was conducted of patients who underwent spinopelvic fixation from January 2014 through December 2018 at a single institution. Patients were grouped into the octogenarian group (OG), 80–89 years old, and comparison group (CG), 40–50 years old. Demographics; pathology; Charlson Comorbidity Index; Hounsfield units; surgery details; and clinical data including complications, intensive care unit and length of hospital stay, and mortality were collected and compared.
Results
Inclusion criteria were met by 26 patients (OG: n = 14; CG: n = 12). Diagnoses in the OG were deformity (42.9%), pseudarthrosis (35.7%), fracture (7.1%), infection (7.1%), and tumor (7.1%). The only significant differences in baseline patient characteristics were that Charlson Comorbidity Index was significantly higher in the OG (6.0 ± 1.4) compared with the CG (1.1 ± 1.0) (P < 0.001) and the OG had lower Hounsfield units (P < 0.001), indicating poorer bone quality. More patients in the CG underwent staged and anterior approaches compared with the OG (P = 0.031). Major and minor complication rates were 57.1% and 42.9%, respectively, in the OG (P = 0.98) and 25% and 25% in the CG (P = 0.34). Mortality rate was 14.3%.
Conclusions
With an aging population, the number of patients requiring spinopelvic fixation will continue to grow. Spine surgeons must carefully weigh benefits and risks in patients with multiple comorbidities.