OBJECTIVE The longitudinal efficacy of anterior cervical discectomy and fusion (ACDF) in the population of older individuals is debated. The authors aimed to determine the long-term outcomes of patients aged ≥ 75 years compared to those of their younger peers. METHODS A prospectively collected quality registry of patients undergoing elective ACDF was retrospectively reviewed. Cohorts included patients who were ≥ 75 years compared to < 75 years of age. Patient-reported outcome measures (PROMs) were collected at baseline and 3, 12, and 24 months postoperatively. Demographics, surgical characteristics, complications, Eating Assessment Tool-10 (EAT-10) dysphagia rates, North American Spine Society satisfaction, and PROMs were compared between groups. All analyses were repeated following 1:1 propensity score matching by demographics, baseline PROMs, comorbidities, symptoms, and surgical factors. RESULTS A total of 1155 patients met inclusion criteria with 1082 (94%) aged < 75 years and 73 (6%) ≥ 75 years. Prior to propensity score matching, the ≥ 75-year cohort had a lower mean BMI (29.0 ± 4.3 vs 30.9 ± 6.6 kg/m 2 , p = 0.028), fewer daily smokers (4.1% vs 16%, p = 0.005), fewer currently employed workers (5.5% vs 52%, p < 0.001), and lower rates of anxiety (15% vs 28%, p = 0.017) and depression (12% vs 23%, p = 0.041). The ≥ 75-year cohort had more osteoarthritis (47% vs 24%, p < 0.001) and coronary artery disease (23% vs 6.5%, p < 0.001). The ≥ 75-year cohort had significantly better neck pain visual analog scale, arm pain visual analog scale (AP-VAS), Neck Disability Index, EuroQol 5-Dimension, and EuroQol visual analog scale baseline scores (all p < 0.05), but similar modified Japanese Orthopaedic Association scores (p = 0.2). By the 2-year follow-up, all PROM scores were similar except for the AP-VAS score, for which the ≥ 75-year cohort reported less arm pain (1.2 ± 2.5 vs 1.7 ± 2.7, p = 0.044). Propensity score matching yielded 138 patients, with 69 in each cohort. Residual demographic differences included the ≥ 75-year cohort having fewer employed workers (5.8% vs 42%, p < 0.001) and more individuals with a professional degree (25% vs 8.7%, p = 0.012). The propensity score–matched cohorts achieved parity in all baseline, postoperative, and change-from-baseline PROM scores through the 2-year follow-up. CONCLUSIONS Patients aged ≥ 75 years experience benefit comparable to that of younger patients across outcome measures following propensity score matching. Age alone does not predict worsened outcomes in carefully selected older patients undergoing elective ACDF, and older patients may benefit from knowledge of comparable favorable outcomes.
OBJECTIVE Studies have shown that patients undergoing multilevel cervical operations are at greater risk for postoperative dysphagia compared to those who undergo single-level operations. This study aimed to compare risk factors for postoperative dysphagia in patients undergoing single- versus multilevel anterior cervical surgery. METHODS A prospectively collected quality registry was retrospectively reviewed to identify candidates who underwent anterior cervical procedures. Procedures involving 1 disc space were categorized as single level, and procedures involving ≥ 2 consecutive disc spaces were categorized as multilevel. Dysphagia rates were determined using Eating Assessment Tool-10 (EAT-10) scores. Univariate and multivariate analyses were performed to identify significant risk factors for postoperative dysphagia within 12 months of surgery. RESULTS Of 1705 patients who met the inclusion criteria, 804 (47.2%) underwent single-level and 901 (52.8%) underwent multilevel procedures. Both groups had similar rates of baseline dysphagia (14% vs 14%, p > 0.9). Multilevel patients had significantly higher rates of dysphagia at 1 month (64% vs 54%, p = 0.001), 3 months (32% vs 25%, p = 0.004), and 12 months (29% vs 21%, p = 0.004) postoperatively. Multivariable regression revealed that for single-level surgery, Black race (OR 2.40, p = 0.021), higher American Society of Anesthesiologists (ASA) class (OR 1.45, p = 0.018), symptom duration for more than 12 months (OR 1.66, p = 0.043), baseline dysphagia (OR 4.53, p < 0.001), diabetes (OR 1.76, p = 0.014), peripheral vascular disease (OR 3.74, p = 0.049), and operations involving C3–4 (OR 2.25, p = 0.004) were independent predictors of postoperative dysphagia within 12 months of surgery. For multilevel procedures, baseline dysphagia (OR 7.31, p < 0.001), diabetes (OR 1.61, p = 0.022), and operations involving C3–4 (OR 1.85, p = 0.011) or C4–5 (OR 1.64, p = 0.010) were independent predictors of postoperative dysphagia, while listhesis (OR 0.63, p = 0.042) was an independent predictor of no postoperative dysphagia. CONCLUSIONS Patients undergoing single-level cervical procedures are at lower risk for postoperative dysphagia. Preexisting dysphagia, diabetes, and the inclusion of upper cervical levels independently contribute to dysphagia risk following both single-level and multilevel surgical procedures. Black race, ASA class, prolonged preoperative symptom duration, and peripheral vascular disease are associated with dysphagia risk particularly in single-level procedures, while listhesis predicts lower dysphagia risk specifically in multilevel surgical procedures. These results can aid patient counseling by providing stratified risk factors for postoperative dysphagia.
OBJECTIVE The efficacy and safety of lumbar microdiscectomy in older compared with younger patients remain subjects of ongoing debate. The aim of this study was to compare postoperative pain relief, functional improvement, and the speed and extent of motor and sensory recovery between patients younger and older than 70 years over a 2-year follow-up period. METHODS Data were prospectively collected from patients undergoing lumbar microdiscectomy for symptomatic disc herniation at a single institution between 2016 and 2025. Patients were stratified into two age groups: < 70 years and ≥ 70 years. Preoperative symptom duration, defined as the period of continuous clinical symptoms leading to the current surgical indication, was prospectively recorded and compared between age groups. Clinical outcomes were assessed using the numeric rating scale for low back pain and radicular leg pain, Oswestry Disability Index as an indicator of functional improvement, and neurological examinations at 6 weeks, 6 months, 12 months, and 24 months postoperatively. RESULTS Of 1220 patients (656 male, median age 47.0 years) included in this analysis, 1037 were aged < 70 years and 83 were aged ≥ 70 years. Both age groups had comparable reductions in low back pain and radicular leg pain, as well as functional improvement throughout the 24-month follow-up. However, significant age-related differences in neurological recovery were observed. Younger patients (age < 70 years) demonstrated significantly faster and more complete recovery of both motor and sensory deficits at all follow-up intervals starting from 6 weeks. At 24 months, residual motor deficits were significantly more prevalent in the older (≥ 70 years) age group, as were residual sensory deficits. CONCLUSIONS While chronological age should not be a contraindication to lumbar microdiscectomy, as excellent pain relief and functional improvement were achieved in both age groups, older patients (≥ 70 years) should be counseled regarding a lower probability of full neurological recovery. These findings emphasize the need for individualized expectations in the aging population, but do not rule out the good effect of microdiscectomy in older patients with lumbar disc herniation.
OBJECTIVE The aim of this study was to assess the short-term outcomes and safety of a novel lever-arm-preserving lumbar laminoplasty (Lap-Lap) compared with standard unilateral laminotomy for bilateral decompression (ULBD) and conventional laminectomy in patients with degenerative lumbar spinal stenosis (LSS). METHODS In a prospective study, 295 patients with severe LSS (lumbar canal stenosis, degenerative lumbar scoliosis, ossification of the ligamentum flavum, central herniation) underwent decompression with Lap-Lap (n = 77), ULBD (n = 120), or laminectomy (n = 98) and were evaluated at 1 year. Outcome measures included visual analog scale (VAS) scores for back and leg pain, the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Roland-Morris Disability Questionnaire (RMDQ), and Zurich Claudication Questionnaire (ZCQ). Lumbar alignment and range of motion (ROM) were assessed preoperatively and 1 year postoperatively using radiographic measurements. To adjust for baseline differences, binary logistic regression analysis was performed for all clinical outcome measures to estimate the odds of achieving clinically meaningful improvement across surgical techniques. RESULTS Operative time was slightly longer for Lap-Lap than for ULBD but similar to laminectomy, and blood loss was minimal in all groups. All 3 groups exhibited pain relief and functional improvement at 1 year. After adjustment, low back pain VAS scores in the Lap-Lap group were comparable with those in the ULBD group and showed greater improvement than in the laminectomy group. On most measures, the Lap-Lap group achieved outcomes equivalent or superior to those of ULBD and laminectomy, with particularly greater improvements in the pain-related disorder, lumbar function, ambulation, and quality of life domains of the JOABPEQ after adjustment. ZCQ scores improved more in the Lap-Lap group than in the ULBD group, whereas RMDQ scores were comparable across the Lap-Lap, ULBD, and laminectomy groups. Lap-Lap also had the lowest complication rate. There were no significant differences in lumbar alignment or ROM across groups. CONCLUSIONS In this short-term study, Lap-Lap provided effective and symmetric bilateral decompression. These features contributed to favorable clinical outcomes, with fewer complications. Given its safety and reproducibility, Lap-Lap represents a promising minimally invasive option for treating LSS, especially in severe cases.
