How to Improve Outcomes of Spine Surgery in Geriatric Patients

BACKGROUND: the incidence of spine surgery in elderly patients is increasing. Geriatric spine surgery has 3 main concerns: osteoporosis, continuing degeneration and more deformity, and comorbidities. Measures taken regarding these concerns would improve results, and elderly patients will experience much more benefit from surgery. This study reviewed the most recent literature to improve outcomes of geriatric spine surgery. METHODS: A literature search of the last 10 years was done. RESULTS: Outcomes of spine surgery using decompressive techniques only are similar to outcomes in younger patients. However, in patients with comorbidities, the outcomes are less favorable with more complications. Complication rates decrease when minimally invasive techniques are used. If a fusion surgery is necessary, especially in cases with deformity correction, complication rates significantly increase up to 60%. Osteoporosis comanagement is necessary to prevent nonunion and implant failure if a fusion surgery is planned. Enhanced recovery after surgery protocols can be an aid to preparation and rehabilitation of elderly patients. A frailty index can help to predict patients with the worst outcomes. Additional psychological support and some other measures will help to reduce the incidence of postoperative delirium. CONCLUSIONS: Geriatric patients pose more concerns for spine surgery. To achieve better outcomes with fewer complications, we must concentrate more on comorbidities in elderly patients. Measures to treat osteoporosis; application of enhanced recovery after surgery protocols for patient preparation; use of less invasive surgical techniques; and good postoperative rehabilitation, pain, and psychological management would help to improve the outcomes of spine surgery in geriatric patients.