title: Effectiveness of surgery for lumbar stenosis and degenerative spondylolisthesis in the octogenarian population: analysis of the Spine Patient Outcomes Research Trial (SPORT) data.
abstract: BACKGROUND
  The purpose of this study was to determine whether surgery is an effective option for the treatment of stenosis of the lumbar spine and degenerative spondylolisthesis in the octogenarian population.
  
  
  METHODS
  An as-treated analysis of patients with lumbar stenosis and degenerative spondylolisthesis enrolled in the Spine Patient Outcomes Research Trial (SPORT) was performed. Patients who were at least eighty years of age (n = 105) were compared with those younger than eighty years (n = 1130). Baseline patient and clinical characteristics were noted, and the difference in improvement from baseline between operative and nonoperative treatment was determined for each group at each follow-up time period up to four years.
  
  
  RESULTS
  There were no significant baseline differences in the primary or secondary patient-reported clinical outcome measures between the two patient age groups. Patients at least eighty years of age had higher prevalences of multilevel stenosis, severe stenosis, and asymmetric motor weakness. Patients at least eighty years of age also had higher prevalences of hypertension, heart disease, osteoporosis, and joint problems at baseline, but they had a lower body mass index and lower prevalences of depression and smoking. Fifty-eight of the 105 patients at least eighty years of age and 749 of the 1130 younger patients underwent operative management. There were no differences in the rates of intraoperative or postoperative complications, reoperation, or postoperative mortality between the older and younger groups. Averaged over a four-year follow-up period, operatively treated patients at least eighty years of age had significantly greater improvement in all primary and secondary outcome measures compared with nonoperatively treated patients. The treatment effects in patients at least eighty years of age were similar to those in younger patients for all primary and secondary measures except the SF-36 (Short Form-36) bodily pain domain and the percentage who self-rated their progress as a major improvement, in both of which the treatment effect was significantly smaller.
  
  
  CONCLUSIONS
  Operative treatment of lumbar stenosis and degenerative spondylolisthesis offered a significant benefit over nonoperative treatment in patients at least eighty years of age (p < 0.05). There were no significant increases in the complication and mortality rates following surgery in this patient population compared with younger patients (p > 0.05).
authors: The Rothman Institute at Thomas Jefferson University, 952 Chestnut Street, Philadelphia, PA 19107-4216. E-mail address for J.A. Rihn: jrhino16@yahoo.com.
authors: Jeffrey A
authors: JA
authors: Rihn
authors: The Rothman Institute at Thomas Jefferson University, 952 Chestnut Street, Philadelphia, PA 19107-4216. E-mail address for J.A. Rihn: jrhino16@yahoo.com.
authors: Alan S
authors: AS
authors: Hilibrand
authors: Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755.
authors: Wenyan
authors: W
authors: Zhao
authors: Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755.
authors: Jon D
authors: JD
authors: Lurie
authors: The Rothman Institute at Thomas Jefferson University, 952 Chestnut Street, Philadelphia, PA 19107-4216. E-mail address for J.A. Rihn: jrhino16@yahoo.com.
authors: Alexander R
authors: AR
authors: Vaccaro
authors: The Rothman Institute at Thomas Jefferson University, 952 Chestnut Street, Philadelphia, PA 19107-4216. E-mail address for J.A. Rihn: jrhino16@yahoo.com.
authors: Todd J
authors: TJ
authors: Albert
authors: Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756.
authors: James
authors: J
authors: Weinstein
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000601:surgery* / Q000628:therapy; D013168:Spondylolisthesis / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome
references: Arch Orthop Trauma Surg. 2013 Sep;133(9):1243-8
references: 23852590
references: J Neurosurg Spine. 2013 Feb;18(2):147-53
references: 23231358
references: Med Care. 1994 Jan;32(1):40-66
references: 8277801
references: Spine (Phila Pa 1976). 1986 Jan-Feb;11(1):28-30
references: 2939566
references: Spine (Phila Pa 1976). 2011 Dec 1;36(25):2197-210
references: 21912308
references: Spine (Phila Pa 1976). 2011 Nov 15;36(24):2061-8
references: 22048651
references: J Bone Joint Surg Am. 2011 Oct 19;93(20):1906-14
references: 22012528
references: J Neurosurg Spine. 2013 Feb;18(2):139-46
references: 23231354
references: Am J Ind Med. 1996 Jun;29(6):584-9
references: 8773718
references: Spine (Phila Pa 1976). 1996 Mar 15;21(6):741-9
references: 8882698
references: N Engl J Med. 2007 May 31;356(22):2257-70
references: 17538085
references: N Engl J Med. 2008 Feb 21;358(8):794-810
references: 18287602
references: J Bone Joint Surg Am. 2008 Sep;90(9):1811-9
references: 18762639
references: Spine (Phila Pa 1976). 2008 Sep 1;33(19):2108-15
references: 18777603
references: J Bone Joint Surg Am. 2009 Jun;91(6):1295-304
references: 19487505
references: Spine J. 2009 Jul;9(7):545-50
references: 19398386
references: JAMA. 2010 Apr 7;303(13):1259-65
references: 20371784
references: Spine (Phila Pa 1976). 2010 Jun 15;35(14):1329-38
references: 20453723
references: BMC Surg. 2010;10:34
references: 21092227