Spine - 2026-04-06 - Journal Article
Age-Stratified Analysis of Posterior Lumbar Fusion Surgeries: Revealing Unique Surgical Patterns and Outcomes in an Aging Population.
Dalton J, Tomlak A, Ng M, Mathew J, Giakas A, Oris RJ, Alexander T, Narayanan R, Pohl NB, Green WA, Schoenberg M, Gaccione L, Syed A, Mula M, Kurd MF, Kaye ID, Rihn JA, Canseco JA, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD
Topics
Key Takeaway
After posterior lumbar decompression and fusion, patients ≥80 years had a 21.17x higher odds of non-home discharge (OR=21.17, P<0.001) but achieved equivalent mortality, readmission, revision rates, and PROM improvement compared to younger cohorts.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This single-center retrospective cohort stratified 1,100 primary elective PLDF patients into five age-decade groups (<50 through ≥80) to compare surgical characteristics, complications, and PROMs. Comorbidity burden and levels fused increased with age until the 70–79 decade then plateaued; patients ≥80 were more likely to receive PLDF alone rather than TLIF. Mortality, 90-day readmission, 1-year revision, and ODI/VAS/PCS improvements were equivalent across all decades, but age ≥80 independently predicted longer LOS (β=0.89) and non-home discharge (OR=21.17) on multivariable regression.
Key Limitation
Retrospective single-center design with inherent selection bias: octogenarians who reached elective surgery represent a functionally optimized cohort, making complication and PROM equivalence potentially non-transferable to unselected elderly patients.
Original Abstract
STUDY DESIGN
Retrospective Cohort.
OBJECTIVE
Compare surgical characteristics, complications, and patient-reported outcome measures (PROMs) by clinically relevant and easily applicable age-decade groups after posterior lumbar decompression and fusion surgery (PLDF).
SUMMARY OF BACKGROUND DATA
Due to an aging population and an increased utilization of spine surgery, spine surgeons must increasingly consider age as a variable that affects surgical risk and outcomes.
METHODS
Patients undergoing primary/elective PLDF at one tertiary center (2017-2021) were included. Outcomes included rates of in-hospital and 30-day mortality, 90-day readmission, 1-year revision, and PROMs- Oswestry Disability Index, SF-12 Physical (PCS) and Mental Component Summary (MCS), and Visual Analog Scale (VAS): Back and Leg. Patients were stratified and compared by age decade.
RESULTS
1100 patients were included (Age: <50-N=90, 50-59-N=212, 60-69-N=385, 70-79-N=334, ≥80-N=79). Increasing age decade was associated with lower BMI. Comorbidities, levels decompressed and fused increased with age decade until 70 then slightly decreased. Patients ≥80 predominantly received PLDF, while those <50 predominantly received TLIF/PLDF. Decade groups were similar regarding rates of in-hospital/30-day mortality, 90-day readmission, 1-year revision, and all PROMs except 6-month and 1-year postoperative MCS. Patients aged 70-79 displayed the best 6-month and 1-year postoperative MCS scores. On multivariable regression, age ≥80 best predicted increased LOS (β=0.89; P<0.001) and non-home discharge (β=3.05; OR=21.17; P<0.001) after accounting for sex, BMI, Charlson Comorbidity Index, operative time, and number of levels fused; age 60-79 showed weaker prediction.
CONCLUSION
Following PLDF, older patients had similar postoperative mortality, readmission, revision, and PROM improvement; however increasing age predicted increased LOS and non-home discharge. These results suggest that patients in advanced age decades derive similar benefits to their younger counterparts, while maintaining an appropriate safety profile. Future studies should further elucidate age-related outcome differences to improve risk stratification and patient counseling.