Challenging Aging Norms in Elective Spine Surgery: Resetting Surgeon Expectations on Octogenarian Survival Outcomes

Introduction: Understanding the sequelae of spinal surgery in the elderly population is becoming increasingly valuable as this populace increases. A substantial gap in literature regarding specific outcomes for octogenarians and nonagenarians necessitates further exploration. Our study aims to look deeper into the outcomes of spinal surgeries in octogenarians, exploring the benefit of surgical intervention.

Methods: We conducted a retrospective analysis of 107 patients ≥80 years of age who underwent spinal interventions from 2019 to 2023. Surgery type (fusion vs nonfusion), mortality, complication rates, and post-operative quality of life metrics were extracted, and ANOVA and chi-squared tests were used to assess outcome differences by age group (80-84, 85-89, and ≥90-year-olds), surgery type, and sex.

Results: Out of the entire patient cohort going back to 2019, 86% of patients are still alive to date with only 15 deaths. Alternatively, we estimate average minimal survival to be at least 22 months. 74 (69%) patients underwent fusion and 33 (31%) underwent decompression without fusion. The cohort consisted of 48 females and 59 males, with the age distribution as follows: 79 patients between 80-84 years, 18 patients between 85-89 years, and 10 patients 90 years or above. The analysis of spinal surgeries in octogenarians showed a moderate benefit, neurological improvement (84.2%), pain improvement (88.4%). There was no significant difference across age groups and sex for survivorship at 4 years (p = 0.420), complication rates (p = 0.7703), neurological deficit improvement (p = 0.9196), or pain improvement (p = 0.6914). Age did not significantly affect outcomes when adjusted for sex, complications, neurological improvement, and pain relief.

Conclusion : We demonstrate that age alone should not be a deterrent as patients survive long enough to confer a benefit from surgery. Nuanced care models that incorporate advocating for surgery to enhance quality of life for this demographic are needed.