Comparison of Patient Outcomes in Minimally Invasive Transforaminal Lumbar Interbody Fusion Between Younger and Older Adults

Introduction: Low back pain is a leading global cause of disability, and its prevalence is expected to rise to 70 million by 2030, with the most significant increase occurring among patients aged 65 and older. Therefore, finding effective surgical interventions for the aging population is crucial in reducing economic cost and post-operative complications. Minimally invasive transforaminal lumber interbody fusion (MIS-TILF) shows promise in reducing morbidity, especially during the early recovery period. Our study evaluates the perioperative and postoperative outcomes between younger and older patients undergoing single- and multi-level MIS-TLIF.

Methods: A single institution retrospective study was performed at Northwestern Memorial Hospital. We identified a total of 479 patients; 275 patients in the younger group (18-64 years, mean: 53.2 years), and 204 patients in the older group (>65 years, mean: 72.0 years). Demographic, operative outcome, and major and minor complication data were collected from the electronic health record and analyzed using a bivariate analysis.

Results: Older patients were found to be more susceptible to minor and major complications during single level procedures, despite there being no differences in surgical time, rate of revision and fusion, or estimated blood loss. There was a significant improvement in post-operative KPS scores for both cohorts during both single and multi-level fusions, though older patients with multi-level fusion had relatively worse pre- and post-operative KPS scores. Older patients were also significantly more likely to have a longer hospitalization regardless of procedure type.

Conclusion : Older patients were found to have comparable outcomes to younger patients during multi-level MIS-TLIF; however, they were more likely to have both minor and major complications during single-level procedures. This suggests the importance of medical optimization and proper patient selection for MIS-TLIF, especially among the older patients compared to young cohorts.