Adult Spine Deformity (ASD) Surgery Outcomes with and without Pedicle Subtraction Osteotomies (PSO) in Patients Over Age 75.

Introduction: The incidence of adult spine deformity (ASD) surgery is increasing as the population ages. Pedicle subtraction osteotomy (PSO) effectively corrects sagittal malalignment but is associated with higher complication rates, particularly in elderly patients. We aimed to compare outcomes between patients over the age of 75 who underwent ASD surgery with and without PSO.

Methods: We retrospectively reviewed 418 patients who underwent ASD reconstruction with greater than five levels fused. 23 patients over the age of 75 with a minimum of 6 months follow-up were identified. We analyzed perioperative data, complications, and clinical outcomes at last follow-up visit. Statistical analyses were performed using t-tests for continuous data and Fisher exact tests for categorical.

Results: We reviewed 8 patients undergoing PSO and 15 without PSO in patients who underwent deformity surgery, all aged over 75, with a mean follow-up of 2 years. PSO patients were older than non-PSO (78.6 ± 3.3 vs. 75 ± 0.3, P = 0.04). Operative time (PSO 5 hrs 6 min vs. non-PSO 4 hrs 56 min, P = 0.8) and hospital stay (PSO 6 days vs. non-PSO 5 days, P = 0.6) were similar in both groups, but blood loss was higher in the PSO group (1.75 L vs. 0.73 L, P = 0.004). Medical complications occurred in 12.5% of the PSO group and 20% of the non-PSO group, P=0.65, and surgical complications were 75% in the PSO group versus 33.3% in the non-PSO group, P=0.09. Most of the surgical complications in the PSO group were dural tears, comprising 57% of the total. Revision rates were similar between the PSO group (75%) and non-PSO group (33.3%), P=0.09. Both groups demonstrated similar improvements in ODI (PSO -11.5 vs. non-PSO -19.8, P = 0.5) and VAS scores (PSO 0.7 vs. non-PSO -5.6, P = 0.1) at the last follow-up.

Conclusion : PSO in elderly patients above 75 resulted in higher rates of blood loss compared to non-PSO deformity correction but similar operative time, hospital stay, clinical outcome improvement, and comparable rates of medical and surgical complications.