Safety of Lumbar Laminectomy in the Elderly

Lumbar spinal stenosis is a common problem as we age. Narrowing of the spinal canal puts pressure on the spinal cord or spinal nerves. Back and leg pain that increases with activity such as walking can be very disabling. Spinal surgery is one treatment option for this condition.

Many studies have concluded that spinal surgery in adults aged 65 and older is risky. It should not be approached lightly. But what are the risks? And who should avoid spinal surgery?

In this study, data from the National Inpatient Sample (NIS) is used to answer these questions. Information from millions of patients from over 1,000 hospitals in 37 states is available in this database. From 1993 to 2002, almost half a million people had a lumbar laminectomy for spinal stenosis.

Analysis of the results for these patients showed the following:

  • Problems and the death rate after spinal surgery for stenosis increases with age
  • Patients 85 years old and older have the highest risk (almost 20 per cent for complications and 1.4 per cent for death)
  • The more health problems a patient has, the greater the risk for problems after spinal surgery
  • Men are at a slightly higher risk than women for complications

    Having other health problems (called comorbidities) raises the risk of surgical complications. Patients with three or more comorbidities were much more likely to be discharged to some other setting than home. These various conditions ranged from heart failure to lung disease to alcohol abuse and depression. Cancer, arthritis, anemia, and thyroid problems are other common problems in older adults facing spinal surgery.

    The National Inpatient Scale represents the largest study of lumbar surgery for spinal stenosis. The results suggest that this procedure has some risks. Surgeons can use a practical method of assessing risk when making treatment decisions with older adults who have spinal stenosis. Taking age and comorbidities into consideration are key factors in the decision-making process.