Elective lumbar spinal decompression in the elderly: is it a high-risk operation?

INTRODUCTION: Spinal degeneration leading to spinal stenosis is increasingly common in an aging population. Many patients are not referred for operation because of the fear of severe complications. The purpose of this study was to relate the surgical risks involved in elective spinal decompression in elderly patients to those of total hip arthroplasty, a well-accepted procedure whose risks and benefits are well known.
METHODS: We reviewed the charts of 6 8 consecutive patients who underwent elective spinal decompression and fitted our inclusion criteria (65-80 yr of age, no spinal or hip operations, no hip fractures, spine fractures or cauda equina syndrome and no bone or metastatic disease). This group was matched with a similar group of 68 randomly selected patients who underwent total hip arthroplasty during the same period. We recorded the age, gender, American Society of Anesthesiologists (ASA) score, early postoperative complication rate, operative time, hospital stay and blood lost.
RESULTS: The 2 groups were well matched with respect to age, gender and ASA score. The only significant intraoperative difference was operative time, with the spine procedure taking longer to complete (191 min v. 278 min). Blood loss was not significantly different. Both groups had a similar number of lift-threatening complications (12 v. 14). The number of minor complications was greater in the spinal decompression group (62 v. 125).
CONCLUSIONS: Elective lumbar spinal decompression in elderly patients suffering significant pain or disability due to degenerative lumbar spinal stenosis is worthwhile. We recommend judicious use of conservative measures, but encourage referral for surgical management when these fail. This operation, even when instrumentation and bone grafting are required, is not associated with more serious or life-threatening risks than a total hip replacement in elderly patients.