80歳以上の超高齢者における脊椎脊髄手術の効果と問題点

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The object of this study was to investigate surgical results and problems associated with spinal surgery in patients older than 80 years of age. Since April, 2003, we have performed 25 operations in 20 elderly patients (7 men and 13 women with ages ranging from 80-89 years) for lumbar lesions (14 cases) and cervical lesions (6 cases). Data obtained from chart review included age, sex, duration of neurological symptoms, associated illnesses, type of anesthesia, time of operation, blood loss during operation, and complications attributable to surgery. Neurological deficits before and after surgery were assessed using the Japanese Orthopedic Association (JOA) score for lumbar lesions, and the Neurosurgical Cervical Spine Scale (NCSS) for cervical lesions. Four patients had histories of heart disease and one had a history of lung disease. Twelve patients with lumbar lesions underwent surgery under lumbar anesthesia, and 2 patients general anesthesia. Mean operation time was 98 minutes, and mean blood loss during surgery was 54 grams in patient with lumbar lesions, and 260 minutes, 138 grams with cervical lesions. Two patients with both cervical and lumbar lesions underwent cervical and lumbar operations simultaneously. In patients with lumbar lesions, the preoperative mean JOA score was 12, and postoperative 19.3, and the mean recovery rate was 43.3%. In patients with cervical lesions, the preoperative mean NCSS was 5.8 and postoperative 8.0, and the mean recovery rate was 29.3%. There were no deaths and three patients had postoperative complications including transient foot drop in one, hypotension in one, and instrumentation failure in the other. Our data suggest that spinal surgery is a reasonable alternative with satisfactory results in patients older than 80 years who are in good general health.
日本脊髄外科学会の論文

80歳以上の超高齢者における脊椎脊髄手術の効果と問題点

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