• Jetan H Badhiwala, Brij S Karmur, Laureen D Hachem, Wilson Jamie R F JRF Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada., Fan Jiang, Blessing Jaja, Aria Nouri, Christopher D Witiw, Farshad Nassiri, Michael G Fehlings, and Jefferson R Wilson.
• Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada.
• Neurosurgery. 2020 Sep 15; 87 (4): 672-678.

BackgroundDegenerative spondylolisthesis (DS) is often treated with lumbar spinal fusion (LSF). However, there is concern that the morbidity of LSF may be prohibitively high in older adults.ObjectiveTo evaluate the impact of advanced age on the safety of LSF for DS.MethodsPatients who underwent LSF for DS were retrospectively identified from National Surgical Quality Improvement Program datasets for 2011 to 2015 using Current Procedural Terminology codes. Data on demographic characteristics, comorbidities, surgical factors, and 30-d morbidity and mortality were collected. Propensity score matching (nearest neighbor) was performed with age (<70 vs ≥70 yr) as the dependent variable and sex, type of fusion procedure, number of levels fused, diabetes, smoking, hypertension, and chronic steroid use as covariates. Outcomes were compared between age <70 and ≥70 groups.ResultsThe study cohort consisted of 2238 patients (n = 1119, age <70; n = 1119, age ≥70). The 2 age groups were balanced for key covariates including sex, race, diabetes, hypertension, CHF, smoking, chronic steroid use, type of fusion, and number of levels. Rates of all complications were similar between younger and older age groups, except urinary tract infection, which was more frequent among the ≥70 age group (OR 2.32, P = .009). Further, patients in the older age group were more likely to be discharged to a rehabilitation (OR 2.94, P < .001) or skilled care (OR 3.66, P < .001) facility, rather than directly home (OR 0.25, P < .001).ConclusionLSF may be performed safely in older adults with DS. Our results suggest older age alone should not exclude a patient from undergoing lumbar fusion for DS.Copyright © 2019 by the Congress of Neurological Surgeons.

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