title: Patients with spinal deformity over the age of 75: a retrospective analysis of operative versus non-operative management.
abstract: The goal of the present study was to compare the outcomes of operative and non-operative patients with adult spinal deformity (ASD) over 75 years of age.
  
  
  
  A retrospective review of a multicenter prospective adult spinal deformity database was conducted examining patients with ASD over the age of 75 years. Demographics, comorbidities, operation-related variables, complications, radiographs, and Health-related quality of life (HRQOL) measures collected included Oswestry Disability Index, Short Form-36, and Scoliosis Research Society-22 preoperatively, and at 1 and 2 years later. Minimum clinically important difference (MCID) was calculated and also compared.
  
  
  
  27 patients (12 operative, 15 non-operative) were studied. There were no significant differences (p > 0.05) between operative and non-operative patients for age, body mass-index, and comorbidities, but operative patients had worse baseline HRQOL than non-operative patients. Operative patients had a significant improvement in radiographic parameters in 2-year HRQOL, whereas non-operative patients did not (p > 0.05). Operative patients were significantly more likely to reach MCID (range 41.7-81.8 vs. 0-33.3 %, p < 0.05). In the surgical group, 9 (75 %) patients had at least 1 complication (24 total complications).
  
  
  
  In the largest series to date comparing operative and non-operative management of adult spinal deformity in elderly patients greater than 75 years of age, reconstructive surgery provides significant improvements in pain and disability over a 2-year period. Furthermore, operative patients were more likely to reach MCID than non-operative patients. When counseling elderly patients with ASD, such data may be helpful in the decision-making process regarding treatment.
authors: Department of Neurosurgery, The Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 5-185, Baltimore, MD, 21287, USA. dsciubb1@jhmi.edu.
authors: Daniel M
authors: DM
authors: Sciubba
authors: Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors: Justin K
authors: JK
authors: Scheer
authors: Department of Neurosurgery, The Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 5-185, Baltimore, MD, 21287, USA.
authors: Alp
authors: A
authors: Yurter
authors: Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA.
authors: Justin S
authors: JS
authors: Smith
authors: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
authors: Virginie
authors: V
authors: Lafage
authors: Department of Orthopaedic Surgery, University of California, Davis, CA, USA.
authors: Eric
authors: E
authors: Klineberg
authors: Department of Orthopaedic Surgery, University of California, Davis, CA, USA.
authors: Munish
authors: M
authors: Gupta
authors: San Diego Center for Spinal Disorders, La Jolla, CA, USA.
authors: Robert
authors: R
authors: Eastlack
authors: San Diego Center for Spinal Disorders, La Jolla, CA, USA.
authors: Gregory M
authors: GM
authors: Mundis
authors: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
authors: Themistocles S
authors: TS
authors: Protopsaltis
authors: Neurosurgical Medical Clinic, San Diego, CA, USA.
authors: Donald
authors: D
authors: Blaskiewicz
authors: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors: Han Jo
authors: HJ
authors: Kim
authors: Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors: Tyler
authors: T
authors: Koski
authors: Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA.
authors: Khaled
authors: K
authors: Kebaish
authors: Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA.
authors: Christopher I
authors: CI
authors: Shaffrey
authors: Rocky Mountain Hospital for Children, Denver, CO, USA.
authors: Shay
authors: S
authors: Bess
authors: Department of Orthopaedic Surgery, Oregon Health and Science University, Portland, OR, USA.
authors: Robert A
authors: RA
authors: Hart
authors: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
authors: Frank
authors: F
authors: Schwab
authors: Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
authors: Christopher P
authors: CP
authors: Ames
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D000072700:Conservative Treatment; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures; D010146:Pain / Q000209:etiology; D011788:Quality of Life; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications / Q000628:therapy*; D013122:Spinal Diseases / Q000150:complications / Q000628:therapy; D013123:Spinal Fusion
keywords: 75 years; Adult spinal deformity; Complications; Elderly; HRQOL; MCID; Non-operative; Scoliosis
references: Spine (Phila Pa 1976). 2006 Jan 1;31(1):99-103
references: 16395185
references: Ochsner J. 2014 Spring;14(1):67-77
references: 24688336
references: Eur Spine J. 2005 Dec;14(10):925-48
references: 16328223
references: Eur Spine J. 2006 Jun;15(6):982-91
references: 15965708
references: Spine (Phila Pa 1976). 2009 Apr 15;34(8):813-7
references: 19365250
references: Spine (Phila Pa 1976). 2013 Apr 20;38(9):726-31
references: 23138408
references: Spine (Phila Pa 1976). 2012 May 20;37(12 ):1077-82
references: 22045006
references: Neurosurgery. 2009 Jul;65(1):86-93; discussion 93-4
references: 19574829
references: Spine (Phila Pa 1976). 2002 Aug 15;27(16):1742-8
references: 12195065
references: Eur Spine J. 2013 Mar;22 Suppl 2:S203-15
references: 23188161
references: Spine (Phila Pa 1976). 2007 Sep 15;32(20):2238-44
references: 17873817
references: Neurosurgery. 2013 Oct;73(4):559-68
references: 23756751
references: Neurosurg Focus. 2003 Jan 15;14(1):e5
references: 15766222
references: J Bone Joint Surg Am. 2008 Sep;90(9):1839-47
references: 18762642
references: Spine (Phila Pa 1976). 2009 Sep 15;34(20):2171-8
references: 19752703
references: Eur Spine J. 2011 Sep;20 Suppl 5:578-85
references: 21796394
references: Clin Orthop Relat Res. 1988 Apr;(229):70-87
references: 2964969
references: Spine (Phila Pa 1976). 2011 Jun 15;36(14):1154-62
references: 21289576
references: Am J Public Health. 1994 Aug;84(8):1292-8
references: 8059888
references: Spine (Phila Pa 1976). 2009 Sep 15;34(20):2165-70
references: 19713875
references: Spine (Phila Pa 1976). 2011 May 1;36(10):817-24
references: 20683385
references: Spine (Phila Pa 1976). 2005 May 1;30(9):1082-5
references: 15864163
references: Spine J. 2008 Nov-Dec;8(6):968-74
references: 18201937
references: Spine (Phila Pa 1976). 2010 Nov 1;35(23):2079-83
references: 20395881
references: Neurosurg Focus. 2014 May;36(5):E3
references: 24785485
references: Rev Chir Orthop Reparatrice Appar Mot. 2003 May;89(3):218-27
references: 12844045
references: J Neurosurg Spine. 2011 Dec;15(6):667-74
references: 21888481
references: Eur Spine J. 2011 Sep;20 Suppl 5:609-18
references: 21809016
references: Spine (Phila Pa 1976). 2005 Feb 15;30(4):468-74
references: 15706346
references: J Bone Joint Surg Am. 2011 Sep 7;93(17):1577-82
references: 21915571
references: Neurosurgery. 2012 Aug;71(2):341-8; discussion 348
references: 22596038
references: Eur Spine J. 2013 Nov;22 Suppl 6:S834-41
references: 24052406
references: Eur Spine J. 1998;7(2):99-103
references: 9629932
references: Spine (Phila Pa 1976). 2011 May 20;36(12):958-64
references: 21192289
references: Eur Spine J. 2011 Sep;20 Suppl 5:626-33
references: 21796393
references: Spine (Phila Pa 1976). 2009 Jul 15;34(16):1693-8
references: 19770610