Clinical Outcome in Lumbar Decompression Surgery for Spinal Canal Stenosis in the Aged Population

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1 Clinical Outcome in Lumbar Decompression Surgery for Spinal Canal Stenosis in the Aged Population Kleinstück FS1, Ulrich NH2, Woernle C2, Winklhofer S3, Burgstaller JM4, Farshad M2, Oberle J5, Porchet F1, Min K2 and the LSOS Group6 Department of Orthopaedics and Neurosurgery, Spine Center, Schulthess Clinic, Zürich, Switzerland of Orthopaedics, University Hospital Balgrist, University of Zürich, Switzerland 3 Department of Radiology, University Hospital Zürich, University of Zürich, Switzerland 4 Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zürich, Switzerland 5 Department of Neurosurgery, Kantonsspital Winterthur, Switzerland 6 Lumbar Spinal Stenosis Outcome Study group, Zürich. 1 2 Department

2 Introduction With the aging of the population, an increasing number of patients with degenerative disorders of the lumbar spine are presenting for surgery. Lumbar decompression surgery without fusion has been shown to improve the quality of life of patients with degenerative lumbar spinal stenosis (LSS). It is unclear whether such findings extend to patients with LSS who are greater than 80 years of age.

3 Aim of the study The aim of the study was to examine whether outcome and quality of life improve after decompression surgery for LSS in patients greater than 80 years of age and to compare the outcomes with a younger patient population from the same patient collective, participating in a multicentre prospective observational study.

4 Methods Patients: Recruited from 8 centres in Zürich, Switzerland, using agreed classification of LSS, surgical procedures to be applied, and follow-up schedule. Admission criteria: no evidence of stenosis caused by tumour, fracture, infection, or significant deformity (>15 lumbar scoliosis); no prior lumbar spine surgery; no notable improvement in condition with conservative treatment; no clinical peripheral artery occlusive disease. Surgery: Standard open posterior lumbar laminectomy or laminotomy at the affected level with no instrumentation.

5 Methods Questionnaires: Pre-op: socio-demographics, medical history Pre-op and 6 and 12 months follow-up: Swiss Spinal Stenosis Measure (*MCIC, 0.5 points) Roland & Morris disability questionnaire (*MCIC, 5 points) Feeling Thermometer scale (*MCIC, 15 points) Pain Numeric Rating Scale (*MCIC, 2 points) EuroQol 5D-3L and EuroQol VAS general health *MCIC: minimal clinically important change score

6 Results The study group comprised 37 patients 80 years old who had reached 12 months follow-up; these were compared with 56 controls, years old. Baseline data for the two age-groups are shown in the Table below. Variable Study group 80 yr Number Controls yr Age at surgery (y) 82.5 ± ± 2.6 Sex (no. (%) female) 17 (46%) 22 (39%) CIRS* 9.9 ± ± 4.2 No. levels decompressed 1.9 ± ± level 11 (29%) 10 (18%) >1 level 26 (71%) 46 (82%) Retired 32 (86%) 55 (98%) *CIRS, cumulative illness rating scale (comorbidity), scored from 0 to 56 (no significant difference between age-groups).

7 Results Swiss Spinal Stenosis Measure Means ± SD Compared with pre-op scores, significant improvements in all subdomain scores at 6 and 12 months follow-up, for both age-groups No significant difference between the groups in their 6 and 12 mo scores

8 Results Feeling thermometer, NRS and EQ VAS general health Means ± SD Compared with pre-op scores, significant improvements in the Feeling Thermometer and NRS scores at 6 and 12 months follow-up, with no significant difference between the age-groups. For EQ-VAS, only the older group ( 80 yr) showed a significant improvement at 6 and 12 months follow-up

9 Results Roland Morris Disability score Means ± SD Compared with pre-op scores, significant improvements in Roland Morris scores at 6 and 12 months follow-up, for both age-groups No significant difference between the groups in their 6 and 12 mo scores

10 Results % patients achieving Minimal Clinically Important Change score at 12 months follow-up Instrument Study group 80 yr Controls yr SSM symptom severity 70.6 % 70.6 % SSM physical function 64.7 % 50.9 % Feeling thermometer 70.6 % 68.6 % NRS 75.0 % 62.0 % Roland Morris Disability 50.0 % 49.0 % P > 0.05 for all group comparisons Complications 80 yrs old: 1 reoperation due to epidural bleeding; 4 intraoperative dural tears, not clinically significant; no wound infections yrs old: 3 reoperations due to epidural bleeding, infection or dural tear

11 Conclusion Our elderly population with symptomatic LSS showed a significant reduction in pain and disability and a significant improvement in quality of life in both the short-term and long-term after lumbar decompression surgery. The majority of patients 80 years old with symptomatic LSS who are deemed healthy enough to undergo decompression surgery can expect a clinically meaningful improvement afterwards.

12 Conflict of interest statement The authors have no conflicts of interest to declare in relation to the presented study. The authors thank the Helmut Horton Foundation and the Pfizer Foundation for Geriatrics & Research in Geriatrics for their support.