title: Surgery for metastatic spine tumors in the elderly. Advanced age is not a contraindication to surgery!
abstract: With recent advances in oncologic treatments, there has been an increase in patient survival rates and concurrently an increase in the number of incidence of symptomatic spinal metastases. Because elderly patients are a substantial part of the oncology population, their types of treatment as well as the possible impact their treatment will have on healthcare resources need to be further examined.
  
  
  
  We studied whether age has a significant influence on quality of life and survival in surgical interventions for spinal metastases.
  
  
  
  We used data from a multicenter prospective study by the Global Spine Tumor Study Group (GSTSG). This GSTSG study involved 1,266 patients who were admitted for surgical treatments of symptomatic spinal metastases at 22 spinal centers from different countries and followed up for 2 years after surgery.
  
  
  
  There were 1,266 patients recruited between March 2001 and October 2014.
  
  
  
  Patient demographics were collected along with outcome measures, including European Quality of Life-5 Dimensions (EQ-5D), neurologic functions, complications, and survival rates.
  
  
  
  We realized a multicenter prospective study of 1,266 patients admitted for surgical treatment of symptomatic spinal metastases. They were divided and studied into three different age groups: <70, 70-80, and >80 years.
  
  
  
  Despite a lack of statistical difference in American Society of Anesthesiologists (ASA) score, Frankel neurologic score, or Karnofsky functional score at presentation, patients >80 years were more likely to undergo emergency surgery and palliative procedures compared with younger patients. Postoperative complications were more common in the oldest age group (33.3% in the >80, 23.9% in the 70-80, and 17.9% for patients <70 years, p=.004). EQ-5D improved in all groups, but survival expectancy was significantly longer in patients <70 years old (p=.02). Furthermore, neurologic recovery after surgery was lower in patients >80 years old.
  
  
  
  Surgeons should not be biased against operating elderly patients. Although survival rates and neurologic improvements in the elderly patients are lower than for younger patients, operating the elderly is compounded by the fact that they undergo more emergency and palliative procedures, despite good ASA scores and functional status. Age in itself should not be a determinant of whether to operate or not, and operations should not be avoided in the elderly when indicated.
authors.affiliation: Department of Orthopedic Surgery, L'Institut Mutualiste Montsouris, Paris, France. Electronic address: aymmed@hotmail.fr.
authors.forename: A
authors.initials: A
authors.lastname: Amelot
authors.affiliation: Department of Orthopedic Surgery, L'Institut Mutualiste Montsouris, Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Balabaud
authors.affiliation: Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London, London, UK.
authors.forename: Z
authors.initials: Z
authors.lastname: Fox
authors.affiliation: Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London, London, UK.
authors.forename: H A
authors.initials: HA
authors.lastname: Crockard
authors.affiliation: Departments of Neurosurgery and Orthopedic Surgery, Thomas Jefferson University and Hospitals, Philadelphia, PA, USA.
authors.forename: T
authors.initials: T
authors.lastname: Albert
authors.affiliation: Department of Neurosurgery, Medical Center Haaglanden, Haaglanden, The Netherlands.
authors.forename: C M
authors.initials: CM
authors.lastname: Arts
authors.affiliation: Departments of Orthopedic and Neurological Surgery, Washington University, MO, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Buchowski
authors.affiliation: Department of Orthopedic Surgery, University Hospital of Aarhus, Aarhus, Denmark.
authors.forename: C
authors.initials: C
authors.lastname: Bunger
authors.affiliation: Department of Neurosurgery, Seoul National University, Seoul, South Korea.
authors.forename: C K
authors.initials: CK
authors.lastname: Chung
authors.affiliation: Department of Neurosurgery, Groningen, The Netherlands.
authors.forename: M H
authors.initials: MH
authors.lastname: Coppes
authors.affiliation: Division of Neurosurgery, University Hospital Leuven, Leuven, Belgium.
authors.forename: B
authors.initials: B
authors.lastname: Depreitere
authors.affiliation: Department of Neurosurgery, Toronto Western Hospital, Toronto, Canada.
authors.forename: M G
authors.initials: MG
authors.lastname: Fehlings
authors.affiliation: Departments of Neurosurgery and Orthopedic Surgery, Thomas Jefferson University and Hospitals, Philadelphia, PA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Harrop
authors.affiliation: Department of Orthopedic Surgery, Kanazawa Medical University Hospital, Kanazawa, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Kawahara
authors.affiliation: Departments of Orthopedic Surgery and Neurosurgery, Samsung Medical Center, Seoul, South Korea.
authors.forename: E S
authors.initials: ES
authors.lastname: Kim
authors.affiliation: Departments of Orthopedic Surgery and Neurosurgery, Samsung Medical Center, Seoul, South Korea.
authors.forename: C S
authors.initials: CS
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Musgrove Park Hospital, Taunton, UK.
authors.forename: Y
authors.initials: Y
authors.lastname: Leung
authors.affiliation: Department of Orthopedics, Peking University Hospital, Beijing, China.
authors.forename: Z J
authors.initials: ZJ
authors.lastname: Liu
authors.affiliation: Spinal Unit, Hospital Universitario Dr Peset, Valencia, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Martin-Benlloch
authors.affiliation: Department of Neurosurgery, Toronto Western Hospital, Toronto, Canada.
authors.forename: E M
authors.initials: EM
authors.lastname: Massicotte
authors.affiliation: Department of Neurosurgery, Technical University of Munich, Munich, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Meyer
authors.affiliation: Department of Orthopedic Surgery, University Medical Center Utrecht, The Netherlands.
authors.forename: F C
authors.initials: FC
authors.lastname: Oner
authors.affiliation: Department of Neurosurgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Peul
authors.affiliation: Centre for Spine Studies and Surgery, Queens Medical Centre, Nottingham, UK.
authors.forename: N
authors.initials: N
authors.lastname: Quraishi
authors.affiliation: Department of Orthopaedic Surgery, Nihon University School of Medicine, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Tokuhashi
authors.affiliation: Department of Orthopedic Surgery, Kanazawa University, Kanazawa, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Tomita
authors.affiliation: Department of Neurosurgery, Charing Cross Hospital, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Ulbricht
authors.affiliation: Department of Orthopedic Surgery, University Medical Center Utrecht, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Verlaan
authors.affiliation: Department of Neurosurgery, Jackson Memorial Hospital, University of Miami, Miami, FL, USA.
authors.forename: M
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Orthopedic Surgery, L'Institut Mutualiste Montsouris, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Mazel
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000075204:Contraindications, Procedure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D011788:Quality of Life; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery*
keywords: Elderly; Emergency; Neurologic prognosis; Quality of life; Scheduled surgery; Spine compression; Spine metastasis