Introduction: As the population ages and safety of many procedures improves, surgical interventions are more often considered a viable treatment option among elderly patients. Traditional thought, however, leads many to favor more conservative treatment options for this population, even in the case of very serious injury or debilitating conditions. This study examines the safety and efficacy of cervical fusion surgery among patients 90 years and older to better characterize the treatment options for cervical pathologies in very elderly patients.
Methods: This study is a retrospective review which includes all cervical fusion procedures performed among patients 90 years of age and older (n=10). The frequency and severity of complications were assessed.
Results: A total of 10 cervical fusions were performed, 9 posterior approaches and 1 anterior approach for the treatment of cervical fractures (n=6), myelopathy (n=2), and stenosis (n=2). The mean age among patients was 91.6 ± 1.5 years (90-95 years of age), 6 males and 4 females were included. American Society of Anesthesiologists Classification (ASA) of 3 was recorded for 8 patients, and an ASA of 4 for 2 patients. An average of 3.4 ± 1.3 vertebral bodies were fused. Preoperative symptoms persisted in 5 of 10 cases (50%), while only one patient developed new neurological symptoms. No patients encountered major surgical complications such as pulmonary embolism, myocardial infarction, cerebral infarct, deep venous thrombosis, sepsis or hardware failure. Only three experienced mild complication, one developing C5 palsy and two requiring postoperative blood transfusion.
Conclusion : This study demonstrates that cervical fusions may be performed safely and effectively among patients of 90 years and older. Henceforth, the procedure warrants consideration as a treatment option among elderly patients suffering from cervical pathologies.
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