title: Complications and outcomes after spinal deformity surgery in the elderly: review of the existing literature and future directions.
abstract: OBJECTIVE
  The elderly population (age > 60 years) is the fastest-growing age group in the US. Spinal deformity is a major problem affecting the elderly and, therefore, the demand for surgery for spinal deformity is becoming increasingly prevalent in elderly patients. Much of the literature on surgery for adult deformity focuses on patients who are younger than 60 years, and therefore there is limited information about the complications and outcomes of surgery in the elderly population. In this study, the authors undertook a review of the literature on spinal deformity surgery in patients older than 60 years. The authors discuss their analysis with a focus on outcomes, complications, discrepancies between individual studies, and strategies for complication avoidance.
  
  
  METHODS
  A systematic review of the MEDLINE and PubMed databases was performed to identify articles published from 1950 to the present using the following key words: "adult scoliosis surgery" and "adult spine deformity surgery." Exclusion criteria included patient age younger than 60 years. Data on major Oswestry Disability Index (ODI) scores, visual analog scale (VAS) scores, patient-reported outcomes, and complications were recorded.
  
  
  RESULTS
  Twenty-two articles were obtained and are included in this review. The mean age was 74.2 years, and the mean follow-up period was 3 years. The mean preoperative ODI was 48.6, and the mean postoperative reduction in ODI was 24.1. The mean preoperative VAS score was 7.7 with a mean postoperative decrease of 5.2. There were 311 reported complications for 815 patients (38%) and 5 deaths for 659 patients (< 1%).
  
  
  CONCLUSIONS
  Elderly patient outcomes were inconsistent in the published studies. Overall, most elderly patients obtained favorable outcomes with low operative mortality following surgery for adult spinal deformity.
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
authors.forename: Doniel
authors.initials: D
authors.lastname: Drazin
authors.forename: Ali
authors.initials: A
authors.lastname: Shirzadi
authors.forename: Jack
authors.initials: J
authors.lastname: Rosner
authors.forename: Paula
authors.initials: P
authors.lastname: Eboli
authors.forename: Michael
authors.initials: M
authors.lastname: Safee
authors.forename: Eli M
authors.initials: EM
authors.lastname: Baron
authors.forename: John C
authors.initials: JC
authors.lastname: Liu
authors.forename: Frank L
authors.initials: FL
authors.lastname: Acosta
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D013122:Spinal Diseases / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome