ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Outcomes of adult spinal deformity surgery in octogenarians - How old is too old?
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Authors and funding
11 authors.
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Abstract
STUDY
designRetrospective multicenter study.
objectivesTo evaluate the safety and efficacy of adult spinal deformity (ASD) surgery in patients aged ≥ 80 years compared to their younger counterparts.
methodsPatients who underwent posterior fusion involving ≥ 5 spinal levels for ASD between 2017 and 2023 at two institutions were included. Patients were stratified into the three groups categorized by age: super-elderly (≥ 80 years), elderly (65-79 years), and middle-aged (50-64 years). Demographics, surgical details, radiographic parameters, patient-reported outcomes, satisfaction at two years, 30-day complications, and rates of proximal junctional failure (PJF) were compared.
resultsA total of 151 patients (44 super-elderly, 79 elderly, and 28 middle-aged) were analyzed. Super-elderly patients had higher ASA scores and a higher rate of osteoporosis than the other groups. Surgical extent and duration were similar, but blood loss was lower in the super-elderly group. Pre-operative PT and SVA as well as post-operative PT were significantly greater in the super-elderly and elderly groups than in the middle-aged group. Leg pain and ODI were significantly worse pre-operatively in the elderly group; however, all post-operative outcomes, satisfaction, short-term complication rates were similar across the three groups. The incidence of PJF increased stepwise across age categories (36% vs. 29% vs. 12%, p = 0.09), while a multivariate analysis revealed super-elderly status was not independently associated with PJF.
conclusionsDespite greater pre-operative deformity, patients aged ≥ 80 years achieved comparable functional and radiographic outcomes to patients aged 65-79 and 50-64. Careful patient selection and pre-operative counseling are essential for optimizing outcomes in this growing surgical population.
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