Postoperativer Vergleich der geriatrischen und nicht-geriatrischen älteren Patienten nach operativer Dekompression des lumbalen Spinalkanals Mittleres Follow-Up von 3,5 Jahren

Objective: Lumbar spinal stenosis (LSS) is a common disease of the older population. Spinal stenosis has been recognized as a complex disorder, challenging to treat, and associated with a large variety of negative consequences, including physical disability, depression, and social isolation and it may cause exacerbation of comorbid diseases. The progressive aging and accessibility of medical diagnostics/care result in an increased number of geriatric patients who undergo surgery for LSS. There are, therefore, many studies engaged with this disease for the purpose of improving treatment quality and decreasing the number of failures. The majority of the studies on LSS define the elderly (geriatrics) from the chronological viewpoint. The definition per se is no longer adequate and requires additional supplements. The aim of this study was to compare geriatric and non-geriatric old patients after LSS surgery, evaluate and present the differences between both groups, and clarify the relevance of geriatric multimorbidity for therapy planning in cases of LSS. Materials and methods: During the period from January 2013 to April 2015, 93 patients aged 70 years and above underwent decompression surgery due to LSS in our department. The mean age at the time of surgery was 76.75 years (SD: 4.47). The patients were divided into two groups: geriatric (GG) and non-geriatric (NGG). The geriatric group consisted of 47 patients (51%) with typical geriatric multimorbidity (average age: 76.6 years, SD: 4.13). The non-geriatric group consisted of 46 patients (49%) without the above-mentioned characteristic (average age: 76.9 years, SD: 4.82). Patients who needed additive nucleotomy or fusion-procedures were excluded. We analyzed the period of hospitalization (including ASA-score, BMI, operated segments, anticoagulants, gender etc.) in both groups, respectively. The patients were contacted and recruited for a follow-up interview about 3 years after LSS surgery. All patients were interviewed on admission using a structured questionnaire during the follow-up interview. The intensity of the pain was described using the visual analog score (VAS) and compared before surgery and during follow-up. Activities of daily living were evaluated at the time of follow-up interview using the Oswestry Disability Index (ODI). Categorical variables were compared using Mann-Whitney-U-Test / Wilcoxon-Mann-Whitney-Test. Results: The mean time elapsed from surgery until follow-up interview was 42.85 months (SD: 6.88). A total of 33 (70%) geriatric and 36 (78%) non-geriatric patients could be recruited for follow-up interview. The rate of complications in the geriatric group was 32% (n=15). In the non-geriatric group, the rate of complications was 9% (n=4). The difference in complication rates between the two groups was statistically significant (p<0.001). There was no significant correlation between ASA-score, BMI, anticoagulants etc., and the rate of complications in our study. The absolute majority of complications was a minor complication. Significantly more analgesics and corticosteroids were applied postoperatively in the geriatric group (p<0.01). In both groups, there was a significant improvement in VAS and neurogenic claudication (p<0.001). Significantly more geriatric patients had recurrent low back pain in the follow-up period (p<0.05). About 19% of non-geriatric patients and only one geriatric patient had no disability according to ODQ (ODI: 0%); the difference was statistically significant (p<0.05). Despite of above mentioned significant differences between the groups, there was an identical rate of satisfaction of geriatric and non-geriatric patients. Conclusion: This study shows many significant differences between the geriatric and non-geriatric older patients during the postoperative and follow-up periods after LSS surgery. The geriatric patients have a higher rate of postoperative complications in relation to that of the non-geriatric older patients. A complete relief from symptomatic LSS will not be expected in the geriatric population despite surgery. To summarize the above conclusions, the division of older patients in terms of geriatric multimorbidity could be helpful in prognostic assessment and therapy planning. The future prospective, multicenter studies should be undertaken to affirm the results of this study so that special care and customized therapy for the geriatric population can be promoted and used in daily clinical practice.