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SPORT study: Surgery for lumbar stenosis can be beneficial to elderly patients
Researchers compared surgery and nonoperative care in octogenarians to younger patients with lumbar stenosis and degenerative spondylolisthesis.
Octogenarians displayed better health outcomes from surgical treatment for lumbar stenosis and degenerative spondylolisthesis than from nonoperative care, according to researchers.
Prior to the start of the study, Jeffrey A. Rihn, MD, and colleagues hypothesized the patients who underwent surgery would have better health outcomes than those who received nonsurgical treatment.
“Four-year data showed that surgically treated patients over the age of 80 had significantly greater improvement over baseline than those treated nonoperatively for all primary and secondary outcome measures,” Rihn said in a presentation. “The treatment effects in patients over the age of 80 were similar to those of patients under 80 for all primary and secondary outcome measures, except for SF-36 bodily pain (BP) score and the percent of patients that self-rated their progress as major improvement,” he said.
The study Rihn presented at the American Academy of Orthopaedic Surgeons Annual Meeting was an as-treated analysis of 105 patients enrolled in the Spine Patient Outcomes Research Trial — SPORT — for lumbar stenosis and degenerative spondylolisthesis who were 80 years or older and received surgical treatment. Their results were compared with patients in the study who received nonoperative treatment.
Investigators included 105 patients who were 80 years and older with a mean age of 83 years and 1,130 patients under the age of 80 years with a mean age of 63.7 years. They measured clinical outcomes at baseline and regular follow-up time intervals through 4 years post-treatment.
Results of the study show that at baseline the older group of patients had a higher incidence of hypertension, heart disease, osteoporosis, joint problems and depression, but a lower body mass index and a lower incidence of smoking as expected, Rihn said. However, the older than 80 patient group had higher incidences of multilevel severe stenosis when compared with the younger than 80 group.
“There is no baseline difference in the primary or secondary outcomes measures” in the two groups, Rihn said, which were the primary Oswestry Disability Index (ODI) score, SF-36 physical function (PF) and SF-36 BP scores. Fifty-eight of the older patients had surgical treatment (66%) compared to 48% of the younger patients. Of the older patients who had surgery 68% underwent decompression only, 14% underwent non-instrumented fusion and 18% underwent instrumented fusion, based on the abstract.
The patients who were older than 80 years, when compared to patients younger than 80 years, had significantly lower scores for the SF-36 BP, trended lower for the stenosis bothersome index, but postoperative SF-36 PF and ODI scores were similar in the two groups, according to Rihn.
“Surgical treatment for lumbar stenosis and degenerative spondylolisthesis is effective in the octogenarian population when compared to nonoperative treatment. There was no increase in complication rate, reoperation rate or mortality,” Rihn said. “Surgery in patients over 80 may not be as effective as patients under 80, and future studies should address issues in cost effectiveness for patients in this population.” – by Robert Linnehan
- Reference:
- Rihn JA. Paper #822. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 11-15, 2014; New Orleans.
- For more information
- Jeffrey A. Rihn, MD, can be reached at Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, The Rothman Institute, 925 Chestnut St., 5th Floor, Philadelphia, PA 19107 USA; email: jrihno16@yahoo.com.
Disclosure: Rihn is a paid consultant to Pfizer and receives research support from DePuy Synthes.