Outcomes of adult spinal deformity surgery in octogenarians - How old is too old?

Abstract

Retrospective multicenter study. To evaluate the safety and efficacy of adult spinal deformity (ASD) surgery in patients aged ≥ 80 years compared to their younger counterparts. Patients who underwent posterior fusion involving ≥ 5 spinal levels for ASD between 2017 and 2023 at two institutions were included. Patients were stratified into the three groups categorized by age: super-elderly (≥ 80 years), elderly (65-79 years), and middle-aged (50-64 years). Demographics, surgical details, radiographic parameters, patient-reported outcomes, satisfaction at two years, 30-day complications, and rates of proximal junctional failure (PJF) were compared. A total of 151 patients (44 super-elderly, 79 elderly, and 28 middle-aged) were analyzed. Super-elderly patients had higher ASA scores and a higher rate of osteoporosis than the other groups. Surgical extent and duration were similar, but blood loss was lower in the super-elderly group. Pre-operative PT and SVA as well as post-operative PT were significantly greater in the super-elderly and elderly groups than in the middle-aged group. Leg pain and ODI were significantly worse pre-operatively in the elderly group; however, all post-operative outcomes, satisfaction, short-term complication rates were similar across the three groups. The incidence of PJF increased stepwise across age categories (36% vs. 29% vs. 12%, p = 0.09), while a multivariate analysis revealed super-elderly status was not independently associated with PJF. Despite greater pre-operative deformity, patients aged ≥ 80 years achieved comparable functional and radiographic outcomes to patients aged 65-79 and 50-64. Careful patient selection and pre-operative counseling are essential for optimizing outcomes in this growing surgical population.