• Ioannis Vasilikos, Panagiotis Fistouris, Marie Therese Krüger, Christoph Scholz, Evangelos Kogias, Roland Roelz, Ronen Sircar, Jürgen Beck, Ulrich Hubbe, and Jan-Helge Klingler.
• Department of Neurosurgery, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany. Electronic address: ioannisvasilikos@icloud.com.
• World Neurosurg. 2020 Jul 1; 139: e754-e760.

BackgroundTechnical advances in minimally invasive spine surgery have reduced blood loss, access trauma, and postoperative length of stay. However, operating on the susceptible group of octogenarians still poses a dilemma because of a plethora of age-related comorbidities. The aim of this study was to investigate the safety of minimally invasive surgery (MIS) transforaminal lumbar interbody fusion (TLIF) in octogenarians.MethodsWe conducted a retrospective single-center study of all patients over 80 years of age who, between March 2009 and February 2014, had undergone MIS TLIF. The primary outcome was recorded major and minor complications within 30 days of surgery.ResultsTwenty-one patients with an average age of 84.1 ± 2.7 years underwent MIS TLIF in 31 levels for degenerative lumbar disk disease with intolerable pain after failure of conservative treatment. Of the patients, 33.3% showed no perioperative complications. In the remaining 66.7%, 6 major complications and 24 minor complications occurred within 30 days of surgery. Two of these patients died within 30 days of surgery because of sepsis and pulmonary embolism (mortality rate 9.5%).ConclusionsOur study spotlighted the susceptible group of octogenarians and evaluated the safety of MIS TLIF. The perioperative morbidity for octogenarians undergoing MIS TLIF is substantial and even higher than for patients over 65 years of age. Two thirds of patients in this subgroup suffer at least 1 complication. The 30-day mortality rate was 9.5%. Therefore, it is advisable for these patients to exploit all available conservative options prior to surgery.Copyright © 2020 Elsevier Inc. All rights reserved.

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