Impact of Advanced Age on Postoperative Outcomes Following Transforaminal Lumbar Interbody Fusion

Introduction: Age 65 years or older is considered a risk factor for worse outcomes after transforaminal lumbar interbody fusion (TLIF). However, few studies have differentiated this cohort from younger patients. This study compares postoperative outcomes among patients 65 years or older of age with a younger cohort after minimally invasive (MIS) TLIF.

Methods: A database was reviewed for adults undergoing primary, elective, single-level MIS TLIF procedures for degenerative pathology from 2008 to 2019. Outcomes included visual analogue scale (VAS) for back and leg, Oswestry Disability Index (ODI), Short Form 12-Item physical component score (SF-12 PCS), and Patient-Reported Outcome Measurement Information System physical function. Outcomes were collected preoperatively and at 6 weeks, 12 weeks, 6 months, and 1 year postoperatively. Patients were categorized as ≥75 years, 65 to 74 years, or <65 years of age. Propensity score matching was performed, and outcome improvement and minimum clinically important difference (MCID) achievement were evaluated by group. MCID achievement was calculated using previously established values.

Results: Our cohort included 51 patients aged younger than 65 years, 47 patients aged 65 to 74 years, and 16 patients aged 75 years or older. No significant perioperative differences or complications existed between groups. The 65- to 74-year group improved in VAS back, leg, and ODI from 6 weeks to 1 year (all P < 0.001) and SF-12 PCS at 12 weeks to 1 year (all P < 0.005). VAS back, ODI, and SF-12 PCS differed between groups preoperatively (P < 0.050), and VAS back and ODI varied at 6 weeks (P < 0.01). VAS leg differed between groups at 12 weeks and SF-12 PCS at 1 year (both P < 0.050). MCID achievement was similar between groups except for VAS leg at 6 weeks (P = 0.038) and 12 weeks (P = 0.023).

Conclusion: Patients 65 years or older of age markedly improved from baseline, similarly to younger patients. Postoperative outcome scores and MCID achievement demonstrated differences between groups at intermittent timepoints. With appropriate selection criteria, patient age may not act as a notable risk factor for successful MIS TLIF procedures.