Age alone not an exclusion factor for spine surgery

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - The results of a literature review support the belief that advanced age, in and of itself, should not be a contraindication for spine surgery.

Although the quality of evidence is "poor," the research to date suggests that elderly patients can expect similar risks and benefits from these operations as their younger peers, researchers from the University of California at San Francisco conclude.

Nonetheless, the review, which is reported in the Journal of the American Geriatrics Society, emphasizes that a number of effective non-surgical therapies exist and that they should be used before surgical treatment is considered.

"Our study was the first that we know of to systematically review the literature on complication rates of spinal surgery in the elderly population," Dr. Christopher P. Ames, who led the review, told Reuters Health.

"Given our rapidly increasing numbers of patients over age 65 in the US this is a very relevant topic," Ames added.

Spine problems in the elderly can cause disabling pain, the researchers note. Potential non-surgical therapies may include physical therapy, steroid shots, opioid painkillers and bracing.

When these measures fail, surgery can provide effective relief, although depending on the operation, the risk of complications can be high, Ames and colleagues note.

For example, in reviewing data from 27 published studies, they found that complication rates of up to 80 percent can be seen with "decompression" procedures.

Overall, the rates of major and minor complications in elderly patients undergoing spine surgery ranged from 0 percent to 21 percent and from 0 percent to 70 percent, respectively.

Still, the results also suggest that good outcomes are often achievable in older patients following spine surgery. For instance, in one of the larger studies, 69 percent of patients experienced an excellent or good result, based on self-reported satisfaction and a widely used visual pain scale.

SOURCE: Journal of the American Geriatrics Society, July 2008.