A retrospective analysis of 513 patients undergoing pedicle subtraction osteotomy for adult spinal deformity by a single surgical team: are elderly patients at an elevated risk for complications?

Objective: This study aimed to assess whether elderly patients (aged ≥ 70 years) face an elevated risk of complications following pedicle subtraction osteotomy (PSO) for adult spinal deformity (ASD) compared with younger patients (< 70 years) and to evaluate if clinical and radiological outcomes differ between these age groups.

Methods: A retrospective analysis of 513 patients undergoing PSO for ASD by a single surgical team between January 2006 and January 2023 was conducted. Patients were categorized by age (≥ 70 years and < 70 years). Data on clinical, demographic, comorbidity, and radiographic details were collected and compared between the groups. For health-related quality of life assessment, the authors recorded the Oswestry Disability Index (ODI), numeric rating scale (NRS), and Scoliosis Research Society-22 revised (SRS-22r) scores preoperatively and at 6 weeks and 1 year postoperatively. Perioperative complications included major (neurological deficit, death, acute myocardial infarction, stroke), minor (ileus, arrhythmia, delirium), and intraoperative (durotomy, vascular injury).

Results: Of 513 patients, 412 were included in the study. Clinical outcomes, as measured by NRS, ODI, and SRS-22r scores, were comparable between groups, with both groups showing significant improvements postoperatively. Radiographic outcomes also showed significant and comparable improvements in sagittal balance and spinopelvic harmony in both groups. Deformity corrections were also well maintained at 1 year postoperatively. The elderly group (mean age 75.48 years) had a higher rate of perioperative complications (44.64%) than the younger group (mean age 59.60 years; 30.33%) (p = 0.0030), primarily minor complications such as delirium and arrhythmia (16.07% vs 8.61%, p = 0.0279). There was no significant difference between groups regarding the major complication rate (elderly group: 20.83% vs younger group: 14.34%, p = 0.1087), intraoperative complication rate (2.98% vs 3.69%, p = 0.6949), short-term complication rate (10.12% vs 8.20%, p = 0.5024), mechanical complication rate (30.95% vs 32.79%, p = 0.6949), and reoperation rate due to mechanical complications (38.46% vs 43.75% p = 0.5470).

Conclusions: Elderly patients undergoing PSO for ASD experience a higher rate of minor complications but can achieve clinical and radiological outcomes that are comparable to those of younger patients. The authors found no significant increase in major, intraoperative, short-term, or mechanical complication rates and their subsequent reoperation rates among the elderly. These findings underscore the effectiveness of PSO in improving the quality of life for patients with ASD across age groups, emphasizing the critical role of personalized perioperative management in enhancing outcomes and minimizing risks for all patients.