title: Minimally Invasive Spinal Surgery in the Elderly: Does It Make Sense?
abstract: Lumbar degenerative disease can have varied pathoanatomy, with stenosis, spondylolisthesis, and scoliosis contributing to significant pain and disability. Among appropriately selected patients, surgical intervention can treat both back pain and leg pain and improve quality of life in a cost-effective manner with an acceptable safety profile. The evolution of minimally invasive surgical (MIS) techniques offers the potential to decrease the physiological impact of surgery and to improve the complication profile while achieving the same spine surgical objectives. The utility of such techniques among elderly patients >65 years of age has not been rigorously evaluated, and this systematic review sought to define the utility and safety of MIS spinal surgery for decompression, interbody fusion, and deformity correction in this population. Review of 2 studies for MIS lumbar decompression reveals that the majority of elderly patients exhibit significant improvements in pain (change in visual analog score for leg pain, 3.4 points) and disability (change in Oswestry Disability Index, 19 points), with inadvertent durotomy in 3% of patients. Review of 4 studies for MIS lumbar interbody fusion reveals robust improvement in pain (change in visual analog score for leg pain, 3.4 points; change in visual analog score for back pain, 7.2 points), with inadvertent durotomy in 5% of patients. Narrative review was performed for adult degenerative deformity correction, revealing that MIS techniques are feasible for managing such patients with acceptable rates of osseous union and complication. On the basis of largely low-quality, retrospective evidence, we recommend that elderly patients should not be excluded from MIS interventions for symptomatic lumbar degenerative spinal disease.
authors.affiliation: *Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada; ‡Department of Surgery and §Techna Research Institute, University of Toronto, Toronto, Ontario, Canada; ¶Department of Orthopedic Surgery, University of Missouri, Columbia, Missouri; ‖Department of Neurosurgery, University of South Florida, Tampa, Florida; #Department of Neurological Surgery, University of Miami, Miami, Florida; **Toronto Western Research Institute, Toronto, Ontario, Canada.
authors.forename: Mohammed F
authors.initials: MF
authors.lastname: Shamji
authors.forename: Christina L
authors.initials: CL
authors.lastname: Goldstein
authors.forename: Michael
authors.initials: M
authors.lastname: Wang
authors.forename: Juan S
authors.initials: JS
authors.lastname: Uribe
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000601:surgery*; D003362:Cost-Benefit Analysis; D019299:Decompression, Surgical / Q000379:methods*; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010147:Pain Measurement; D011788:Quality of Life; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013130:Spinal Stenosis / Q000601:surgery*; D013168:Spondylolisthesis / Q000601:surgery*; D016896:Treatment Outcome