Is There an Age Limit for Major Spine Surgery?

Adult spinal deformity, which can result from disk degeneration, spinal arthritis, and prior surgeries that fail to align the spine, is an increasing problem among aging Americans. Today many people over the age of 60 expect to be more active in their later years, and an increasing number of them are opting for surgery to alleviate symptoms of spinal deformity and slow further degeneration.

Major spine surgery can often be dismissed as too risky for elderly patients, but there is evidence that this population can have good outcomes and that rates of morbidity and mortality are generally low.  

“We’ve seen that some elderly patients have even better outcomes than their younger counterparts,” said Christopher Ames, MD, co-director of the UCSF Spine Center. “It’s very encouraging to know patients’ lives can be significantly improved and they can be active and mobile after treatment for these conditions in their later years.” This year Ames was nominated for the Scoliosis Research Society’s Hibbs and Whitecloud awards in recognition of his work on novel methods of risk stratification and complication prediction for adult spinal deformity. 

Orthopaedic surgeon Shane Burch, MD, has seen similar positive results for many of his elderly patients. “Our team recently operated on a 94-year-old female patient with scoliosis and saw remarkable improvement in her ability to walk and participate in activities of daily living,” he said. But these results are largely anecdotal, based on individual surgeon experience and retrospective analyses, and there have been few prospective studies with long-term follow-up.

The UCSF Spine Center has recently completed enrollment for a prospective, multicenter study that will follow outcomes for patients over the age of 60 who have undergone spinal fusion of five or more levels for moderate or severe spinal deformity. Improvement in health-related quality of life will be measured using a validated patient questionnaire (SRS-22r), comparing scores from baseline and 24 months. Data will be captured at 13 sites in North America, Asia, and Europe.

Ultimately, analyses of the data gathered through this study will result in improved metrics for selecting the patients who are most likely to have successful surgery without serious morbidity or mortality.

While this study examines multi-level fusion, some older patients with less severe deformity may be good candidates for minimally invasive procedures that can be done on an outpatient basis. Over 150 operations are performed every year, making UCSF home to one of the largest spinal deformity practices in the United States. This vast experience allows neurosurgeons and orthopaedic surgeons to individualize treatment according to deformity type, age and other patient-specific factors and activity goals.