Jeffrey A Rihn1, Alan S Hilibrand1, Wenyan Zhao2, Jon D Lurie2, Alexander R Vaccaro1, Todd J Albert1, James Weinstein3. 1. The Rothman Institute at Thomas Jefferson University, 952 Chestnut Street, Philadelphia, PA 19107-4216. E-mail address for J.A. Rihn: jrhino16@yahoo.com. 2. Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755. 3. Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756.
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).
RCT Entities:
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: Jeffrey A Rihn; Alan S Hilibrand; Kristen Radcliff; Mark Kurd; Jon Lurie; Emily Blood; Todd J Albert; James N Weinstein Journal: J Bone Joint Surg Am Date: 2011-10-19 Impact factor: 5.284
Authors: Owoicho Adogwa; Ryan Owens; Isaac Karikari; Vijay Agarwal; Oren N Gottfried; Carlos A Bagley; Robert E Isaacs; Joseph S Cheng Journal: J Neurosurg Spine Date: 2012-12-11
Authors: Kristen E Radcliff; Jeff Rihn; Alan Hilibrand; Timothy DiIorio; Tor Tosteson; Jon D Lurie; Wenyan Zhao; Alexander R Vaccaro; Todd J Albert; James N Weinstein Journal: Spine (Phila Pa 1976) Date: 2011-12-01 Impact factor: 3.468
Authors: Owoicho Adogwa; Ricardo K Carr; Katherine Kudyba; Isaac Karikari; Carlos A Bagley; Ziya L Gokaslan; Nicholas Theodore; Joseph S Cheng Journal: J Neurosurg Spine Date: 2012-12-11
Authors: Anna N A Tosteson; Tor D Tosteson; Jon D Lurie; William Abdu; Harry Herkowitz; Gunnar Andersson; Todd Albert; Keith Bridwell; Wenyan Zhao; Margaret R Grove; Milton C Weinstein; James N Weinstein Journal: Spine (Phila Pa 1976) Date: 2011-11-15 Impact factor: 3.468
Authors: Patawut Bovonratwet; Matthew L Webb; Nathaniel T Ondeck; Jonathan J Cui; Ryan P McLynn; Praveen Kadimcherla; David H Kim; Jonathan N Grauer Journal: Int J Spine Surg Date: 2019-04-30