Surgical Complications in Elderly Patients with Degenerative Lumbar Spondylolisthesis

Overview

This retrospective study analyzed 678 cases of patients aged 60 to 80+ undergoing open posterolateral arthrodesis for degenerative lumbar spondylolisthesis and stenosis. It compared postoperative complication rates across age groups, finding that complication rates were not significantly different when premorbid profiles were similar.

Background

Degenerative spondylolisthesis (DS) involves anterior displacement of a vertebra due to facet joint arthritis and ligamentous degeneration, often accompanied by spinal stenosis. Surgical fusion and decompression are common treatments, though the superiority of surgery over conservative management remains unclear. With increasing life expectancy and improved surgical techniques, more elderly patients, including those in their eighties, are undergoing lumbar fusion, necessitating evaluation of age-related surgical risks.

Data Highlights

Key Findings

• Complication rates (early surgical, late surgical, and medical) did not significantly differ between patients aged 60s, 70s, and 80s when premorbid risk factors were comparable.
• Preoperative risk factors such as ASA class, BMI, osteoporosis, anticoagulant/antiaggregant use, and diabetes status influenced complication rates more than chronological age alone.
• Standardized perioperative management including anticoagulant bridging and antibiotic prophylaxis was applied uniformly across age groups.
• The mean follow-up duration was approximately 4 years and 9 months, allowing assessment of both early and late complications.
• Patients on anticoagulant or antiplatelet therapy underwent cardiological evaluation and tailored bridging protocols to minimize bleeding risks.

Clinical Implications

Age alone should not be considered a contraindication for lumbar fusion surgery in patients with degenerative spondylolisthesis and stenosis. Careful preoperative assessment of comorbidities and optimization of modifiable risk factors are critical to minimize postoperative complications. Standardized perioperative protocols, including anticoagulant management, contribute to favorable outcomes even in octogenarians.

Conclusion

Open posterolateral arthrodesis with decompression can be safely performed in patients aged 80 and above with degenerative lumbar spondylolisthesis, provided that premorbid health status is adequately managed. Surgical decision-making should prioritize individual risk profiles over chronological age.

References

1. Newman and Stone 1960 -- Coining of the term 'spondylolisthesis'
2. Herbiniaux 1782 -- First clinical case of spondyloptosis
3. IRCCS Istituto Ortopedico Galeazzi et al. 2012-2020 -- Retrospective study on lumbar fusion outcomes