• Jonathan Rychen, Sarah Stricker, Luigi Mariani, Stefan Schaeren, and Gregory F Jost.
• Spine Surgery, University Hospital Basel, Basel, Switzerland; Department of Neurosurgery, University Hospital Basel, Basel, Switzerland.
• World Neurosurg. 2019 Mar 1; 123: e457-e464.

BackgroundIncreased life expectancy has led to indications for spine surgery in patients older than 90 years, but data on associated risks and outcome are lacking.MethodsIndication, type of surgery, complications, functional outcome, and mortality were retrospectively collected from all patients aged 90 years or older operated between 2006 and 2016 at the University Hospital Basel, Switzerland.ResultsSixty-nine patients were included, of which 55% had degenerative, 36% traumatic, and 9% other pathologies. Most surgeries (84%) were performed electively and 16% as emergencies. More than a third (36%) of elective and 58% of emergency surgeries required stabilization. The complication rate was 54% in the elective surgery group (ELSG) and 125% in the emergency surgery group (EMSG). Stabilization (P = 0.006) and emergency surgeries (P = 0.032) were significant risk factors for experiencing complications. Six weeks after surgery, 80% of the patients reported symptomatic improvement. More than half (58%) of the patients in the ELSG reached their specific median life expectancy, compared with 38% in the EMSG. Seventeen percent of patients in the EMSG versus 0% in the ELSG died in the first 3 months after surgery. In the nonstabilized group, 67% of the patients reached their median life expectancy, compared with 38% of the stabilized group.ConclusionsElective spinal surgery in patients older than 90 years of age does not reduce life expectancy and has a good functional outcome for well-selected patients, whereas emergency surgery and stabilization surgery in this age group are associated with a high rate of complications and higher mortality.Copyright © 2018 Elsevier Inc. All rights reserved.

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