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Elderly Patients Older than 75 Years Undergoing Reconstructive Spinal Deformity Surgery Have Significantly Improved Health-Related Quality of Life Measures versus those Managed Nonoperatively Despite High Surgical Complication Rate

Introduction Elderly patients with adult spinal deformity (ASD) often report worse health-related quality of life (HRQOL) than younger patients. Increasing age is associated with increased surgical morbidity. The objective of this study was to compare the outcomes of patients with ASD older than 75 years managed operatively (OP) and nonoperatively (NONOP). Materials and Methods A retrospective review of a multicenter prospective ASD database was conducted. Inclusion criteria included age ≥ 75 years, ASD. Demographics, comorbidities, radiographs, complications, and HRQOL measures collected included pain with visual analog scale (VAS), Oswestry Disability Index (ODI), Short Form-36 (SF-36), and Scoliosis Research Society-22 (SRS22) at baseline, 1 and 2 years. Results A total of 32 patients met criteria (OP: 17, NONOP: 15), all had a minimum 2-year clinical and radiographic follow-up. Of the 32 patients, 13 were at least 80 years of age. There were no significant differences between OP and NONOP for age, BMI, and Charlson Comorbidity Index (p > 0.05 for all). OP had worse baseline ODI, PCS, SRS Activity, Appearance, and Total than NONOP (p < 0.05 for all). There were no significant differences in any baseline radiographic parameters. OP had significant improvement in LL, C7SVA, PI–LL, ODI, PCS, and all SRS subdomains except mental compared with pre-op (p < 0.05 for all). OP had significantly higher 2-year SRS appearance and satisfaction (p < 0.05) than NONOP. There were no significant differences between baseline and 2-year HRQOL for NONOP (p > 0.05). Of the 17 OP patients, 10 (58.8%) had at least one complication with a total of 27 complications including a 64.7% rate of PJK and a 35.3% rate of reoperation. Conclusion Elderly patients ≥ 75 years undergoing ASD surgery had significantly improved HRQOL and radiographic measures over baseline at 2 years compared with a similar nonoperative cohort, despite substantial operative morbidity. This data may be used for preoperative patient counseling in this high-risk elderly population.