Medicare has asked for more proof that spinal arthrodesis (fusion) in older adults really helps. Until now, most of the studies reported on younger adults. And age could make a difference. We can’t just assume that the results of this procedure in younger adults would be the same in older adults. An advisory committee from the Centers for Medicare and Medicaid Services asked for conclusive evidence to support the use of spinal fusion in patients 65 years of age or older. This age-group includes the Medicare population.
A group of orthopedic surgeons from Kentucky, Minneapolis, Boston, and Georgia took up the challenge and conducted a study to help answer this question. The surgeons fused a single spinal level of 224 patients and then followed them for two years to see the results. The group was divided into two groups by age. Anyone younger than 65 years was in the first group. Patients 65 years old and older were in the second group.
In general, the patients in each group were very similar (e.g., education, occupation, alcohol use, general health) except for age. Men and women were included. The main differences were that the younger patients rated their pain higher. They were more likely to still be working and a Worker’s Compensation claim. And the older patients were more likely to have advanced spine degeneration with bone spurs, thickened spinal ligaments, and facet (spine) joint degeneration.
Results were measured using several well-known research tools. These included the Oswestry Disability Index (ODI), the Medical Outcomes Study SF-36, and the numeric rating scale for back and leg pain. X-rays and CT scans were also used to look at the fusion site and see if it was successful or not. These imaging studies showed the presence of bone bridging the vertebral segment (a sign of successful fusion) and any cracks in the bone (a sign of weakness or instability).
Everyone in both groups had significant improvements in their test scores. But the older group demonstrated a larger change in scores indicating greater improvement compared to the younger patients. Complications in the early postoperative period (first 30 days) were higher among the older adults. Half of the older group had an adverse event after surgery. This was compared to one-third of the younger group. Most of the problems were minor.
More studies are needed to look at the differences in results of lumbar spinal fusion based on age and number of levels fused. Surgeons try to select the right procedure for each patient and the best patient (candidate) for each procedure. Choosing patients carefully for spinal fusion increases the chances of a good result. When you see an orthopedic surgeon for an evaluation, ask him or her this question. Their experience may be able to give you some additional insight that can help you with this decision.