Lumbar fusion in octogenarians: the promise of minimally invasive surgery.

Study Design: Retrospective chart review of prospectively collected data from 2 nonrandomized, nonconcurrent cohorts.

Objective: Early results of 2 lumbar interbody fusion procedures-open posterior lumbar interbody fusion (PLIF) and minimally invasive (extreme lateral interbody fusion [XLIF])-were compared in octogenarians to demonstrate the safety of each in the extreme elderly populations.

Summary Of Background Data: Although spinal pathologies are common in the elderly patients, additional health conditions often preclude operative treatment because anesthesia, blood loss, and recovery are too demanding. Minimally invasive approaches reduce procedure-related morbidity and recovery time.

Methods: In our single-site prospective series of XLIF patients, 40 were identified as those aged ≥80 years with a minimum of 3-month follow-up. A complete, retrospective review of surgical patients treated in the same practice with traditional open posterior (PLIF) approach found 20 patients aged ≥80 years. Comparisons were made between groups to identify differences in morbidity and mortality rates.

Results: No clinically significant differences in demographics, diagnoses, or comorbidities were found between groups. Complication rate, blood loss/transfusion rate, and hospital stay were significantly lower in the minimally invasive surgery (MIS) group (P < 0.0001). MIS patients left the hospital an average of 4 days earlier than the open PLIF patients, most discharged home (92.5% XLIF vs. 0% PLIF) rather than to skilled nursing facilities. Six deaths occurred in the PLIF follow-up, 3 within 3 months postoperatively; there was 1 death at 6 months postoperatively XLIF.

Conclusion: Surgical treatment need not be withheld on the basis of age; elderly patients can successfully be treated using MIS techniques, and are-in our experience-among the most satisfied with their outcomes, enjoying significant improvements in pain, mobility, and quality of life.