The Role of Minimally Invasive Spinal Surgical Procedures in the Elderly Patient: An Analysis of 49 Patients Between 75 and 95 Years of Age

As the population gets older, yet remains active, the number of patients presenting with symptomatic spinal disease over the age of 75 increases. These include pain from osteoporotic spinal fractures, lumbar degenerative disease, as well as radiculopathy or neurogenic claudication from stenosis over the age of 75 and older increases. While some of these patients are very healthy, taking minimal medication, many are not good candidates for more invasive surgical procedures under general anesthesia because of medical co-morbidities such as insulin-dependent diabetes and medication use such as anti-coagulants. Past reviews of lumbar surgery in elderly patients have examined the risk factors with spinal fusion and multilevel surgery and many were written before the recent advent of more minimally invasive spinal procedures that reduce both operative time and the need for general anesthesia. This review examines effectiveness in return to activity and reduction in pain in these elderly patients stratified by underlying disease category, i.e. fractures, stenosis with neurogenic claudication and chronic pain, rather than just by the procedure, since there are often several minimally invasive procedures that are available. This review demonstrates very similar pain relief outcomes as measured by the visual analog scale (VAS) scores which dropped in the range of 70% or more with the different procedures. Since the majority of these procedures involve short surgical times and minimal blood loss with small incisions that lower the risk of wound infection as well as cardio-respiratory stress and can be performed under local anesthesia as an outpatient, they are particularly advantageous for the properly selected elderly patient.