Lumbar decompression and fusion in a centenarian.
The incidence of chronic and debilitating conditions in the aging population is steadily increasing, and the treatment of extreme elderly patients with spinal conditions can be challenging. Spinal stenosis and spondylolisthesis can dramatically affect patient quality of life, and patients commonly seek a surgical solution for their condition. Many extreme elderly patients are cautioned against surgery secondary due to their high complication and in-hospital mortality rates when compared with younger patients. This article describes the oldest patient (101 years old) in the English literature with severe spinal stenosis and spondylolisthesis who underwent primary lumbar decompression and fusion. His symptomatology dramatically affected his quality of life, and he was denied surgical care at another institution secondary to his advanced age and high potential risks. A successful outcome was ultimately achieved, and he was able to return to a higher level of physical functioning and social participation prior to his death of unrelated causes 3 years later. This case questions the strict indications of surgery in less-than-ideal and extreme elderly surgical candidates. The authors believe that surgery should not be denied in extreme elderly patients who have failed conservative treatment modalities and continue to have functional impairments. Successful spinal surgery may allow extreme elderly patients an improved quality to the remainder of their life.
Department of Orthopaedic Surgery, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106, USA. ryangarcia78@gmail.com
Ryan M
RM
Garcia
Jonathan
J
Belding
Henry H
HH
Bohlman
D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011859:Radiography; D013123:Spinal Fusion / Q000379:methods*; D013130:Spinal Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013168:Spondylolisthesis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome