Rajkishen Narayanan, Omar H Tarawneh, Jonathan Dalton, Robert J Oris, Mark Miller, Nicholas B Pohl, Tariq Z Issa, Matthew Meade, Olivia Opara, Emily Berthiaume, Yunsoo Lee, Yashas Reddy, Grace Bowen, Harry Lightsey, Ian D Kaye, Mark F Kurd, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder
{"title":"老年人群腰椎融合翻修术的临床效果。","authors":"Rajkishen Narayanan, Omar H Tarawneh, Jonathan Dalton, Robert J Oris, Mark Miller, Nicholas B Pohl, Tariq Z Issa, Matthew Meade, Olivia Opara, Emily Berthiaume, Yunsoo Lee, Yashas Reddy, Grace Bowen, Harry Lightsey, Ian D Kaye, Mark F Kurd, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder","doi":"10.1097/BRS.0000000000005216","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>To examine the profile of older patients undergoing revision lumbar fusion and to evaluate the impact that advancing age may have on outcomes following revision lumbar fusion.</p><p><strong>Background: </strong>The proportion of older patients undergoing revision lumbar fusion is increasing; however, the benefit of revision lumbar fusion in an aging demographic is not well documented.</p><p><strong>Patients and methods: </strong>Patients aged 55+ who underwent revision lumbar between 2011 and 2022 were included and were stratified into age groups: 55 to 64, 65 to 74, and 75+. Primary outcomes consisted of postoperative emergency department visits, 30 and 90-day readmissions, all-cause reoperations, and the need for secondary revisions. Secondary outcomes included patient-reported outcome measures (PROMs) obtained preoperatively, and at 3 months and 1 year postoperatively.</p><p><strong>Results: </strong>A total of 914 patients were included: 55 to 64 years (n = 512, mean: 61.1 yr), 65 to 74 years (n = 296, mean: 69.1 yr), and 75+ (n = 106, mean: 78.9 yr). Adjacent segment disease as a revision indication significantly increased with age (P = 0.001). A circumferential approach was used most (N = 200, 39.7%) in patients 55 to 64, whereas a posterior-only approach was used in 86.3% of patients 75+ (P < 0.001). Levels decompressed increased with age, from 1.67 in the youngest group to 2.04 in the oldest (P < 0.001). The number of levels fused showed no significant difference (P = 0.068). Ninety-day readmissions and the need for secondary revisions did not vary by age. Age groups were not independently associated with ΔPROMs at 1 year, but the oldest groups continued to experience improvement in PROMs in line with their younger counterparts.</p><p><strong>Conclusion: </strong>Patients 75 years and older derive similar benefits from revision lumbar fusion compared with their younger counterparts with no increased risk of emergency department visits, readmissions, or reoperations. Clinicians should be advised that there remains significant value in revising older patients when indicated.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":"50 8","pages":"E151-E157"},"PeriodicalIF":2.6000,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Clinical Outcomes of Revision Lumbar Fusion in the Aging Population.\",\"authors\":\"Rajkishen Narayanan, Omar H Tarawneh, Jonathan Dalton, Robert J Oris, Mark Miller, Nicholas B Pohl, Tariq Z Issa, Matthew Meade, Olivia Opara, Emily Berthiaume, Yunsoo Lee, Yashas Reddy, Grace Bowen, Harry Lightsey, Ian D Kaye, Mark F Kurd, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder\",\"doi\":\"10.1097/BRS.0000000000005216\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>To examine the profile of older patients undergoing revision lumbar fusion and to evaluate the impact that advancing age may have on outcomes following revision lumbar fusion.</p><p><strong>Background: </strong>The proportion of older patients undergoing revision lumbar fusion is increasing; however, the benefit of revision lumbar fusion in an aging demographic is not well documented.</p><p><strong>Patients and methods: </strong>Patients aged 55+ who underwent revision lumbar between 2011 and 2022 were included and were stratified into age groups: 55 to 64, 65 to 74, and 75+. Primary outcomes consisted of postoperative emergency department visits, 30 and 90-day readmissions, all-cause reoperations, and the need for secondary revisions. Secondary outcomes included patient-reported outcome measures (PROMs) obtained preoperatively, and at 3 months and 1 year postoperatively.</p><p><strong>Results: </strong>A total of 914 patients were included: 55 to 64 years (n = 512, mean: 61.1 yr), 65 to 74 years (n = 296, mean: 69.1 yr), and 75+ (n = 106, mean: 78.9 yr). Adjacent segment disease as a revision indication significantly increased with age (P = 0.001). A circumferential approach was used most (N = 200, 39.7%) in patients 55 to 64, whereas a posterior-only approach was used in 86.3% of patients 75+ (P < 0.001). Levels decompressed increased with age, from 1.67 in the youngest group to 2.04 in the oldest (P < 0.001). The number of levels fused showed no significant difference (P = 0.068). Ninety-day readmissions and the need for secondary revisions did not vary by age. Age groups were not independently associated with ΔPROMs at 1 year, but the oldest groups continued to experience improvement in PROMs in line with their younger counterparts.</p><p><strong>Conclusion: </strong>Patients 75 years and older derive similar benefits from revision lumbar fusion compared with their younger counterparts with no increased risk of emergency department visits, readmissions, or reoperations. Clinicians should be advised that there remains significant value in revising older patients when indicated.</p><p><strong>Level of evidence: </strong>Level III.</p>\",\"PeriodicalId\":22193,\"journal\":{\"name\":\"Spine\",\"volume\":\"50 8\",\"pages\":\"E151-E157\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-04-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Spine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BRS.0000000000005216\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/11/19 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BRS.0000000000005216","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/11/19 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Clinical Outcomes of Revision Lumbar Fusion in the Aging Population.
Study design: Retrospective cohort.
Objective: To examine the profile of older patients undergoing revision lumbar fusion and to evaluate the impact that advancing age may have on outcomes following revision lumbar fusion.
Background: The proportion of older patients undergoing revision lumbar fusion is increasing; however, the benefit of revision lumbar fusion in an aging demographic is not well documented.
Patients and methods: Patients aged 55+ who underwent revision lumbar between 2011 and 2022 were included and were stratified into age groups: 55 to 64, 65 to 74, and 75+. Primary outcomes consisted of postoperative emergency department visits, 30 and 90-day readmissions, all-cause reoperations, and the need for secondary revisions. Secondary outcomes included patient-reported outcome measures (PROMs) obtained preoperatively, and at 3 months and 1 year postoperatively.
Results: A total of 914 patients were included: 55 to 64 years (n = 512, mean: 61.1 yr), 65 to 74 years (n = 296, mean: 69.1 yr), and 75+ (n = 106, mean: 78.9 yr). Adjacent segment disease as a revision indication significantly increased with age (P = 0.001). A circumferential approach was used most (N = 200, 39.7%) in patients 55 to 64, whereas a posterior-only approach was used in 86.3% of patients 75+ (P < 0.001). Levels decompressed increased with age, from 1.67 in the youngest group to 2.04 in the oldest (P < 0.001). The number of levels fused showed no significant difference (P = 0.068). Ninety-day readmissions and the need for secondary revisions did not vary by age. Age groups were not independently associated with ΔPROMs at 1 year, but the oldest groups continued to experience improvement in PROMs in line with their younger counterparts.
Conclusion: Patients 75 years and older derive similar benefits from revision lumbar fusion compared with their younger counterparts with no increased risk of emergency department visits, readmissions, or reoperations. Clinicians should be advised that there remains significant value in revising older patients when indicated.
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Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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