Lumbar fusion offers more benefits for older patients

TORONTO — Following lumbar fusion, patients 65 years or older — the Medicare-age population — improved much more than younger patients, according to data from a randomized study conducted by investigators at three centers.

The differences in outcomes between the two groups were greatest at the 6-month follow-up, according to Steven D. Glassman, MD, of the Leatherman Spine Center, Louisville, Ky. Revision rates were about the same in both groups.

“We think that this study demonstrates a substantial benefit for a Medicare-age population treated by single-level lumbar decompression and fusion,” Glassman said.

He presented findings from the 224-patient study at the North American Spine Society 23rd Annual Meeting, here.

Fusion rates were slightly better in the older patient population based on radiographic and CT scan outcomes, he added.

Glassman said some of the impetus for conducting the study was the informal challenge governmental groups like the Centers for Medicare and Medicaid gave the spine community to more closely investigate outcomes of various procedures in their Medicare-age patients.

He and colleagues from the University of Minnesota in Minneapolis and the Hughston Clinic in Columbus, Ga., arrived at their conclusions by studying patients in the control arm of the recombinant human bone morphogenetic protein-2 investigational device exemption (IDE) trial, who underwent one-level fusions with iliac crest bone graft.

Investigators included in their study 50 patients older than 65 years and 174 patients younger than 65 years old from the IDE trial. Some demographic differences existed between the groups, Glassman said.

Overall, there were more older patients who experienced a 10-point drop in Oswestry Disability Scores by 2 years postop compared to the younger patient group. “Not surprisingly, there were more adverse events in the older patients versus the younger patients, including for all events and serious events,” he said.

Glassman has indicated he receives royalties and research support from and is a paid consultant to Medtronic.

Reference:
Glassman SD, Polly DW, Bono CM, et al. Outcome of lumbar fusion in patients over 65 years old. Paper #5. Presented at the North American Spine Society 23rd Annual Meeting. Oct. 15-18, 2008. Toronto.