465 - Analysis of Operative Outcomes in Elderly Patients Following Circumfer...

Oral Posters: MIS

Presented by: N. Anand - View Audio/Video Presentation (Members Only)

Author(s):

N. Anand(1), J. Cohen(1), R. Cohen(1), B. Khandehroo(1), S. Kahwaty(1), E. Baron(1)

(1) Cedars Sinai Medical Center, Spine Center, Los Angeles, CA, United States

Abstract

Introduction: The impact of age on operative outcomes after CMIS correction for adult spinal deformity (ASD) has not been well studied. Often, more extreme correction is reserved in elderly patients to prevent the operative toll and further blood loss. Some have proposed that for the elderly population, favorable outcomes can be achieved despite less stringent correction in the sagittal plane. This study was conducted to analyze clinical and radiologic outcomes of elderly patients who underwent CMIS correction for ASD.

Methods: This is a retrospective study from a single center registry database of all patients who underwent CMIS correction for ASD (Cobb angle > 20 degrees or SVA > 50 mm or PI/LL mismatch > 10) from January 2007 to May 2014. All patients were treated with MIS strategies using MIS Lateral Lumbar Interbody Fusion (LLIF) with percutaneous pedicle screw and rod instrumentation. 124 patients underwent surgery at 3 or more levels. Only patients with an age > 69 years were included. 47 patients were identified and analyzed based on baseline and post op clinical and radiologic outcomes.

Results: In total, 47 patients were identified with a mean age of 75.64 (70-85, SD 3.85). Mean blood loss after single and double-staged procedures was 309.47 ml (20-2000, 335.93) and 404.17 ml (50-2500, 460.23), respectively (table 1). Mean baseline HRQOL scores (VAS: 6.66 (1-10, SD 2.36), ODI: 47.06 (15-80, SD 13.69)) were significantly decreased at the final follow-up visit (VAS: 3.48 (0-8, SD 2.31), ODI: 33.44 (0-69, SD 17.69)) (p < .05). Baseline and follow-up mean Cobb-angles were 27.76° (6.1-59.56, SD 11.55) and 11.91° (1.5-28.21, SD 7.55), respectively (p < .05). SVA trended higher at baseline compared to follow-up but was not statistically significant (baseline: 59.54 mm (-16.59-151, SD 46.57), follow-up: 47.14 mm (-4.79-114.84, SD 33.49) (table 2). The rate of pseudoarthrosis, PJK and major complications was 4.26%, 8.51%, and 31.91%, respectively (table 3).

Conclusion: We found significant mean VAS and ODI score improvements at follow-up in elderly patients with minimal to moderate blood loss. This may suggest MIS correction is an effective alternative to open surgery in elderly patients owning to a reduced operative footprint.

Outcomes