Adult Spine Deformity (ASD) Surgery Outcomes with and without Pedicle Subtraction Osteotomies (PSO) in Patients Over Age 70.

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 70 who underwent ASD surgery with and without PSO.

Methods: We retrospectively reviewed 418 patients who underwent ASD surgery with greater than five levels fused. 61 patients over the age of 70 with a minimum of 6 months follow-up were identified. We analyzed perioperative data, complications, and clinical outcomes at the last follow-up visit. Statistical analyses were performed using t-tests for continuous data and Fisher exact tests for categorical.

Results: We analyzed 17 patients undergoing PSO and 44 without PSO in patients who underwent ASD surgery, all aged over 70, with a mean follow-up of 2 years. Operative time (PSO 4 hrs 56 min vs. non-PSO 4 hrs 34 min, P = 0.5) and hospital stay (PSO 6.6 days vs. non-PSO 5.8 days, P = 0.2) were similar in both groups, but blood loss was higher in the PSO group (1.58 L vs. 0.75 L, P< 0.001). Medical complications occurred in 11.8% of the PSO group versus 13.6% of the non-PSO group, P=0.8, and surgical complications occurred in 52.9% of the PSO group compared to 25% in the non-PSO group, P=0.06. The most common surgical complication in the PSO group were dural tears, (comprising 36% of the surgical complications) while neurologic deficits (38%) were the most common in the non-PSO Group. Revision rates were similar between the PSO group (23.5%) and non-PSO group (16%), P=0.5. Both groups demonstrated similar improvements in ODI (PSO –20 vs. non-PSO –17, P = 0.7) and VAS scores (PSO -4.3 vs. non-PSO –5, P = 0.7) at the last follow-up.

Conclusion : PSO in elderly patients above 70 resulted in higher rates of blood loss compared to non-PSO deformity correction but similar operative time, length of stay, clinical outcome improvement, and comparable rates of medical and surgical complications.