Lumbar Fusion in Octogenarians The Promise of Minimally Invasive Surgery

Study Design. Retrospective chart review of prospectively collected data from 2 nonrandomized, nonconcurrent cohorts. Objective. Early results of 2 lumbar interbody fusion procedures-open posterior lumbar interbody fusion (PLIF) and minimally invasive (extreme lateral interbody fusion [XLIF])-were compared in octogenarians to demonstrate the safety of each in the extreme elderly populations. Summary of Background Data. Although spinal pathologies are common in the elderly patients, additional health conditions often preclude operative treatment because anesthesia, blood loss, and recovery are too demanding. Minimally invasive approaches reduce procedure-related morbidity and recovery time. Methods. In our single-site prospective series of XLIF patients, 40 were identified as those aged >= 80 years with a minimum of 3-month follow-up. A complete, retrospective review of surgical patients treated in the same practice with traditional open posterior (PLIF) approach found 20 patients aged >= 80 years. Comparisons were made between groups to identify differences in morbidity and mortality rates. Results. No clinically significant differences in demographics, diagnoses, or comorbidities were found between groups. Complication rate, blood loss/transfusion rate, and hospital stay were significantly lower in the minimally invasive surgery (MIS) group (P < 0.0001). MIS patients left the hospital an average of 4 days earlier than the open PLIF patients, most discharged home (92.5% XLIF vs. 0% PLIF) rather than to skilled nursing facilities. Six deaths occurred in the PLIF follow-up, 3 within 3 months postoperatively; there was 1 death at 6 months postoperatively XLIF. Conclusion. Surgical treatment need not be withheld on the basis of age; elderly patients can successfully be treated using MIS techniques, and are in our experience among the most satisfied with their outcomes, enjoying significant improvements in pain, mobility, and quality of life.