Perioperative safety and short-term clinical outcomes of spinal fusion in patients aged 85 years and older: a 5-year single-center retrospective study

Abstract

Objective: To evaluate the perioperative safety and short-term clinical outcomes of spinal fusion in patients aged 85 years and older, comparing traumatic and degenerative indications. Methods: We retrospectively reviewed 28 consecutive patients aged ≥85 years who underwent spinal fusion (transforaminal, posterior, or anterior lumbar interbody fusion) at a single high-volume center between January 2020 and December 2024, out of 432 patients aged ≥85 years undergoing spinal surgery. Complications were classified as major or minor and outcomes as satisfactory or unsatisfactory, assessed at discharge or the first outpatient visit. Categorical associations used the Fisher exact test. Results: The mean age was 87.3 years. Degenerative disease was present in 16 patients (57.1%) and traumatic injury in 12 (42.9%). Satisfactory outcomes were achieved in 21 of 28 patients (75.0%). Overall complications occurred in 12 patients (42.9%): major in 3 (10.7%) and minor in 9 (32.1%). No significant association was found between major complications and anesthesia type (P=0.24) or comorbidities (all P≥0.90). The traumatic group had a lower complication rate than the degenerative group (25.0% vs. 56.3%, P=0.14). The mean hospital stay was 15.8 days. Conclusion: Spinal fusion in carefully selected patients aged ≥85 years was associated with a 10.7% major complication rate and a 75.0% satisfactory outcome rate. Outcomes were perioperative and short-term; long-term outcomes were not evaluated. With only 3 major complication events, the study was underpowered to confirm or exclude associations with comorbidities; these findings are preliminary.