Long fusions to the sacrum in elderly patients with spinal deformity

Long spinal deformity fusions in elderly patients continue to be controversial. However, there is a growing population of elderly patients with spinal deformities that may be optimally treated by reconstructive surgery requiring a long fusion to the sacrum. This study evaluated clinical outcomes in elderly (> 65) adult deformity patients who underwent posterior instrumented reconstruction consisting of fusion from the thoracic spine to the sacrum with iliac fixation. Patients in a prospective database for adult spinal deformity who had a posterior reconstruction with an instrumented fusion from the thoracic spine to the sacrum that included iliac fixation with minimum 2-year follow-up were identified. Two cohorts were compared: patients 65 years and older and patients 55 years and younger. Student's t test for independent groups was used to determine any significant differences between continuous variables. Chi-square was used to compare categorical demographic variables between the two groups. The 65 and older group consisted of 15 patients with an average age of 71 years (range 65-78 years). The 55 and younger group consisted of 25 patients with an average age of 45 years (range 30-55 years). The older group had a worse mean co-morbidity score (4.6 vs. 2.1). Baseline SRS scores were similar between groups. Baseline SF-12 data showed worse PCS (22.1 vs. 32.0, p = 0.009) yet better MCS (63.6 vs. 48.4, p < 0.0001) in the older group. Although major curve magnitude was similar (47.1A degrees vs. 42.6A degrees), the older group had more positive sagittal imbalance at baseline (115.7 vs. 54.2 mm, p = 0.02). Number of levels fused, operative time, blood loss, and incidence of complications were similar between groups. Two-year improvements in SRS subscores, SF-12 PCS, and MCS were not significantly different between groups. Properly selected patients 65 years of age and older who have substantial sagittal imbalance, a considerable disease burden, and a lesser degree of mental distress can obtain as much clinical benefit as their younger counterparts (a parts per thousand currency sign55 years of age) 2 years following spinal deformity surgery that requires fusion from the thoracic spine to the sacrum with segmental instrumentation and iliac fixation.