PMID- 31731010 OWN - NLM STAT- MEDLINE DCOM- 20210628 LR - 20210628 IS - 1878-1632 (Electronic) IS - 1529-9430 (Linking) VI - 20 IP - 4 DP - 2020 Apr TI - Does increasing age impact clinical and radiographic outcomes following lumbar spinal fusion? PG - 563-571 LID - S1529-9430(19)31071-X [pii] LID - 10.1016/j.spinee.2019.11.003 [doi] AB - BACKGROUND CONTEXT: Despite the growing senior population within the United States, there is a lack of consensus regarding the safety and efficacy of performing lumbar spinal fusion for this population. PURPOSE: To evaluate the clinical and radiographic outcomes in different age cohorts following lumbar spinal fusion. STUDY DESIGN: Retrospective cohort analysis. PATIENT SAMPLE: Analysis of 1,184 patients who underwent posterolateral lumbar fusion from 2011 to 2018. Surgery was indicated after failure of conservative treatment to address radiculopathy and/or neurogenic claudication. Patients were excluded if they were under 18 years of age at the time of surgery, had a lumbar fracture, tumor, or infection, or had fusions involving the thoracic spine, high-grade spondylolisthesis, or concomitant deformity. Of the 1,184 patients, 850 patients were included. Patients were divided into three roughly equal groups for analysis: young (18-54 years), middle-aged (55-69 years), and senior (>/=70 years). OUTCOME MEASURES: Visual Analog Scale Back/Leg pain, and Oswestry Disability Index (ODI) were collected, and achievement of minimal clinically important difference was evaluated. Lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and PI-LL difference were measured on radiographs. Rates of postoperative complications were analyzed. METHODS: Several radiographic parameters were measured using plain radiographs obtained at preoperative, immediately postoperative (standing radiographs performed on postoperative day 1), and most recent follow-up visits. Preoperative and final patient-reported outcomes, along with demographic information, were obtained all patients. Binary outcome variables were compared between groups with multivariate logistic regression, and continuous outcome variables were compared using multivariate linear regression, with age 18 to 54 years used as the reference. Multivariate regressions were used to compare outcomes between cohorts while controlling baseline characteristics. RESULTS: A total of 850 patients were included; 330 young (38.80%), 317 middle-aged (37.30%), and 203 senior (23.90%). Seniors had higher postoperative length of stay compared to younger patients (p<.001). Younger patients had worse final ODI scores compared to middle-aged patients (p=.002). Seniors had higher rates of proximal ASD (p=.002) compared to young patients. There was no difference in achievement of minimal clinically important differences (MCID) between all three groups. CONCLUSIONS: Senior patients have significant improvement in patient-reported clinical outcomes, despite having greater comorbidities, and longer length of stay. However, given a general lack of achievement of MCID across all cohorts, these findings suggest the need for a critical re-evaluation of the role of lumbar spinal fusion in the management of patients with refractory radiculopathic and/or neurogenic claudication symptoms. CI - Copyright (c) 2019 Elsevier Inc. All rights reserved. FAU - Khan, Jannat M AU - Khan JM AD - Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, MI, USA. FAU - Basques, Bryce A AU - Basques BA AD - Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA. Electronic address: brycebasques@gmail.com. FAU - Harada, Garrett K AU - Harada GK AD - Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA. FAU - Louie, Philip K AU - Louie PK AD - Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA. FAU - Chen, Ian AU - Chen I AD - Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA. FAU - Vetter, Christian AU - Vetter C AD - Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA. FAU - Kadakia, Karishma AU - Kadakia K AD - Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA. FAU - Elboghdady, Islam AU - Elboghdady I AD - Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA. FAU - Colman, Matthew AU - Colman M AD - Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA. FAU - An, Howard S AU - An HS AD - Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA. LA - eng PT - Journal Article DEP - 20191112 PL - United States TA - Spine J JT - The spine journal : official journal of the North American Spine Society JID - 101130732 SB - IM MH - Adolescent MH - Adult MH - Animals MH - Humans MH - *Lordosis MH - Middle Aged MH - Retrospective Studies MH - *Spinal Fusion/adverse effects MH - *Spondylolisthesis MH - Treatment Outcome MH - Young Adult OTO - NOTNLM OT - Age OT - Clinical outcomes OT - Lumbar fusion outcomes OT - MCID OT - Patient reported outcomes OT - Sagittal EDAT- 2019/11/16 06:00 MHDA- 2021/06/29 06:00 CRDT- 2019/11/16 06:00 PHST- 2018/11/26 00:00 [received] PHST- 2019/11/04 00:00 [revised] PHST- 2019/11/08 00:00 [accepted] PHST- 2019/11/16 06:00 [pubmed] PHST- 2021/06/29 06:00 [medline] PHST- 2019/11/16 06:00 [entrez] AID - S1529-9430(19)31071-X [pii] AID - 10.1016/j.spinee.2019.11.003 [doi] PST - ppublish SO - Spine J. 2020 Apr;20(4):563-571. doi: 10.1016/j.spinee.2019.11.003. Epub 2019 Nov 12.