A narrative review of treatment of the elderly patient: do we need to alter surgical management of lumbar spine disease?

Background and Objective: The population is aging, with an increasing proportion of elderly patients who have higher rates of lumbar spine pathology and comorbidities with elevated surgical risk. Concern has been raised for the safety and efficacy of spine surgery for elderly patients although the existing literature is contradictory. This review evaluated reported surgical risks and outcomes for lumbar spinal surgery in elderly patients and considered techniques and perioperative programs to reduce harm for these patients. Methods: A narrative review of lumbar spine surgery in elderly patients was completed including a MEDLINE database search and evaluation of relevant articles and their references through May 2023 in the English language. Representative cases were also reviewed to illustrate these findings. Key Content and Findings: Risk for surgical complication is associated with age -related comorbidity and frailty. However, most studies of lumbar spine surgery including well -optimized elderly patients over age 65 who have failed nonsurgical management report clinical improvements, acceptable complication rates, and durable outcomes similar to younger patients. Super -elderly patients over age 80 also benefit from surgery with similar risks; however, the comorbidities associated with older age may increase surgical risk in this population. Although surgical invasiveness is associated with higher rates of surgical complications, elderly patients still benefit from fusion and instrumentation when properly indicated similar to younger patients. Improving surgical and anesthesia techniques as well as enhancing perioperative optimization can reduce variability in outcomes regardless of age. Conclusions: Age alone is not a contraindication for lumbar spine surgery. Although evidence remains weak, surgery is an option for elderly patients with studies reporting safety and efficacy similar to younger patients. Elderly patient must be informed of both the risks and benefits of surgery depending on their own medical and functional status. Shared surgical decision -making must be on a case -by -case basis to safely achieve patients' goals.