Clinically Meaningful Improvement Across Ages 50-95 Years After Decompression Without Fusion for Central Lumbar Spinal Stenosis Without Spondylolisthesis.

Abstract

Objective: Advanced age has been proposed as a risk factor for worse outcomes and higher complication rates after spinal surgery. We assessed whether decompression for central lumbar spinal stenosis (CLSS) provided meaningful improvement in patients aged 50-95 years.

Methods: We evaluated preoperative and 1-year postoperative Numerical Rating Scale (NRS) leg and back pain, Oswestry Disability Index (ODI), and complications in 17,987 patients aged ≥50 years undergoing decompression without fusion for CLSS without spondylolisthesis from the Swespine register. Meaningful improvement was defined using minimal clinically important difference (MCID) thresholds for NRS leg/back pain and ODI. Across 5-year age groups, we assessed the proportions improving ≥MCID and odds ratios (ORs) with 95% confidence intervals (CIs), using ages 65-69 years as the reference group.

Results: Across age groups, 71%-80% improved ≥MCID in ≥1 outcome. Compared with the reference group, ORs (95% CI) for ≥MCID improvement were lower in ages 70-74 (0.8; 0.7-1.0), 75-79 (0.7; 0.6-0.8), 80-84 (0.6; 0.5-0.7), and 85-89 (0.6; 0.5-0.8); no other age groups differed. 5%-12% experienced complications. Compared with the reference group, ORs (95% CI) for complications were higher in ages 75-79 (1.3; 1.1-1.6), 80-84 (1.7; 1.4-2.1), and 85-89 (2.0; 1.5-2.8), and lower in ages 55-59 (0.7; 0.5-0.9).

Conclusion: 77% of patients aged 50-95 years improved ≥MCID after decompression without fusion for CLSS without spondylolisthesis. Although outcomes were slightly worse and complication rates higher in older than younger patients, decompression without fusion remains effective across this age range.