Because of controversies on the clinical outcome, complication and mortality of spinal surgery in geriatric patients with the spinal stenosis or spondylolisthesis, we herein reviewed the literature about spinal surgery for geriatric patients, focusing on the diagnosis of spinal stenosis and spondylolisthesis which are most commonly encountered in a clinical practice of spinal surgeon.
There was no randomized clinical trial or non-randomized prospective study in regard to mortality in spine surgery of elderly patients. The quality of the data is poor. There were two retrospective studies on the mortality ()., Oldridge, et al. compared postoperative mortality in 34418 elderly patients, who underwent lumbar surgery under the diagnosis of spinal stenosis or spondylolisthesis, with age-matched healthy group. Relative risk of expected mortality was lower than 1, which indicates that mortality was not increased by surgery. Kim, et al. investigated 10-year survival of elderly patients who underwent spinal surgery under the diagnosis of spinal stenosis and compared them with age- and gender-matched controls of general population. The standardized mortality ratios were 0.45 in patients aged 70 to 85 who underwent spinal surgery, showing lower mortality rate in the surgery group. To summarize the mortality data, more than 3500 elderly patients over 65 years old who underwent lumbar surgery were followed up for 1 to 10 years, and the result showed that mortality did not increase in elderly patients compared with age-adjusted control group who did not undergo spinal surgery.,
Lumbar spinal stenosis causes low back and leg pain
In each spinal vertebra there are 2 joints composed of inferior and superior articular processes. These are called facet joints and are the main articulations between adjacent vertebrae. The facet joints are held in place by fibrous tissue called capsules. As part of the normal degenerative process, the facet capsules become thin and weakened. This results in a stretching of the capsule and a sliding of one vertebra on another. This sliding of one vertebra on another is called spondylolisthesis. As a result of this sliding, there is instability in the joint and the body responds via a thickening (hypertrophy) of the facets. This hypertrophy can sometimes compress the structures adjacent to the bony facets, such as the nerves or spinal canal. This results in spinal stenosis (pressure on the nerves in the low back). Spinal stenosis is commonly seen with degenerative spondylolisthesis and is a cause for the many symptoms seen with this disease.
Spinal Stenosis from Spondylolisthesis - Spondylolisthesis
A detailed computerized literature search using the MEDLINE search engine was employed using medical subject terms of "lumbar vertebrae", "surgery", and "geriatric". This database consists of literature published from January 1967 through December 2013. We included English language articles regarding clinical outcome, complication, or mortality after surgical treatment for geriatric patients older than 65 years old with spinal stenosis or spondylolisthesis. Articles regarding the surgical treatment for the geriatric patients with the diagnoses of disc herniation, scoliosis, fractures or infection were excluded. Review articles or case reports with less than ten patients were excluded. All full-text articles were read by two reviewers independently; each article was read by both the first author and one of the coauthors. In case of inconsistencies between two reviewers, the consensus was established through a discussion between them. We then categorized the articles as randomized clinical trial, non-randomized prospective study, and retrospective study for overall quality of the article. Finally, to focus on the most recent evidence, we limited our review to those published on or after 1986. We identified 39685 articles regarding lumbar surgery, among which 70 articles were about geriatric lumbar surgery and 21 dealt with geriatric lumbar surgery for spinal stenosis or spondylolisthesis. One article was excluded because it did not provide specific information about their diagnosis and age of study population, one other article was excluded because it dealt with patients younger than 65 years old, and another article was excluded because it included patients with heterogenous spinal diseases such as spinal stenosis, spondylolisthesis, herniated nucleus pulposus, instability, and scoliosis into the study population. Finally, we found one non-randomized prospective and seventeen retrospective studies that met the study criteria (,,,). However, there was no randomized clinical trial that met the study criteria.