Hello. My name is Michael Carsey. I'm a chief neurosurgical resident at the University of Utah, and I'd like to discuss our multi-center study entitled Outcomes and Risks with Age in Spondylolisthesis in Comparison of the Elderly from the Equality Outcomes Database. We have a number of disclosures. Minority of lumbar spondylolisthesis is a significant spine disorder in the U.S. with approximately 3% to 20% incidence, with increased incidence over the last decade due to the aging of the population. There's an approximate incidence of lumbar spondylolisthesis of 30% in the elderly, with 12% rate of progression. The definition of what constitutes an elderly patient varies depending on whether you're looking at the American Geriatric Society or the World Health Organization or the literature. There is increased question as to the efficacy of spine decompression and fusion in adult patients and specifically in the elderly population. We sought to perform a multi-center registry analysis using the Equality Outcomes Database of the 12 highest-enrolling centers. We included patients undergoing surgical decompression and or fusion for grade 1 spondylolisthesis patients who were enrolled from July 2014 to June of 2016, and we specifically divided the patients into four age categories, less than 60 to 70, 71 to 80, and greater than 80 years of age. Patients and surgical variables were evaluated, as well as a number of quality-of-life metrics, such as the Oswestry Disability Index, the EQ5D Visual Analog Scale, and the North American Spine Society Satisfaction Survey. These are the different centers that were enrolled, and they included a mix of academic as well as private practice multi-specialty groups. A total of 608 patients were included, with a majority in the less than 60 and 60 to 70 year categories. There was a significantly higher comorbidity rate for patients that were elderly, including higher rates of diabetes, coronary artery disease, and osteoporosis. Elderly patients had a significantly higher ASA grade. There was a significantly higher rate of back pain dominant symptoms in the younger patients, whereas there was a mix more of back and leg pain symptoms in the elderly patients. There otherwise was no significant difference in ambulation, motor deficits, or duration of symptoms. Elderly patients did show a higher number of MIS procedures in this database. This was later adjusted for a multivariate regression and discussed further. In terms of our quality-of-life metrics, there were significant improvements in all the metrics that were evaluated in this study, including numeric rating scale, back pain and leg pain, the EQ5D, as well as the Oswestry Disability Index. And this was seen persisting up to 24 months' time, and regardless of age. We usually repeat measures ANOVA so that patients were compared to themselves after adjusting for both the length of time from the surgery as well as their age bracket. North American Spine Society Satisfaction Survey is quite a powerful tool for evaluating the efficacy of surgery and simply asks, did patients benefit from surgery or would they undergo surgery again? And the results here suggested that the vast majority of patients were improved from surgery or would undergo surgery again to get the same results. And this was seen across different age categories up to 24 months' period of time. The minimal clinically important difference for the various quality-of-life metrics was evaluated. And again, the vast majority of patients, anywhere from 60% to 80% achieved the MCIDs for their various quality-of-life metrics, and there was no difference based on age category. There was a lower EBL and length of operating time in the elderly. The elderly did have a higher rate of decompression rather than decompression and fusion, which was more in the younger patients. We discussed this further in our multivariate analysis. There was a higher rate of non-home disposition in the elderly, mainly the need for nursing facilities and rehabilitation. The majority of patients across different age groups stated that surgery met their expectation. There was no difference in 30-day readmission rate, which ranged from about 2.5% to 3.9%. No difference in three-month readmission rate and no difference in re-operation rate up to two years' time across different age groups. A multivariate logistic regression seeking to evaluate the achievement of MCID across these various quality-of-life metrics was performed. This helped to adjust for the variation in various comorbidities, back versus leg pain predominant symptoms, arthrodesis versus decompression alone. The results of this analysis suggested that after adjusting for various factors, age was not significantly different in terms of a factor that impacted quality-of-life metrics. Notations of this study are that this is a multi-center study, including both academic and prior practice locations, and it may not be reflective of all practices in the U.S. There likely is institutional and regional variation in the selection of patients as well as treatment that is performed. There was a limited number of elderly patients who actually underwent a fusion of this procedure. The vast majority underwent decompression alone, and this was adjusted for in the multivariate regression. Enrollment and treatment was dictated by individual providers. This is a registry. This is not a prospective prescribed trial, so treatments and preferences were relegated to the different institutions and the various authors that are on this study. The conclusion is that age is a factor, but not an absolute contraindication to spine fusion for spondylolisthesis. We'd like to thank Kirsten Krauss for editorial support in creation of this manuscript, which is now published and can be found in the Spine Journal. We'd like to thank the NREF for funding, as well as the QOD participating sites and leadership for their efforts in helping develop the data to analyze for this study.

spine decompression and fusion

elderly population

quality-of-life metrics

spondylolisthesis patients

age