Poster Presentation 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

INTRODUCTION: There is little information available on the use of lumbar total disc replacement (TDR) in patients more than 60 years of age. Traditionally there had been concern of the safety of the anterior approach in older patients. Another age-related concern was the safety of these motion preserving devices as patients age versus stabilizing the spine with fusion. The purpose of this study was to investigate the clinical outcome in patients aged 60 years or older at the time of lumbar TDR surgery and also of those who became over 60 years of age in long-term follow-up.

METHODS: Records were reviewed to identify two subsets of patients: 1) those who were >60 years of age at the time of TDR surgery, and 2) those who became more than >60 years of age during long-term follow-up. Data collected included visual analog scales (VAS) separately assessing back and leg pain, Oswestry Disability Index (ODI), and re-operations. For patients who had not been seen recently in the clinic, collection of follow-up data was attempted through mailings and/or telephone calls.

RESULTS: There were 36 patients who underwent TDR at age 60 or older. An additional 127 patients were younger at the time of TDR and became >60 years of age during long-term follow-up (Table 1). There was statistically significant improvements (all p<0.01) in VAS back pain scores and ODI scores in both groups (Table 1). Mean leg pain scores improved in both groups, but statistically significantly so in the group >60 years of age at long-term follow-up. In the group of patients more than 60 years of age at the time of TDR surgery, there were no cases of TDR removal or revision. In the group of patients who became >60 during long-term follow-up, there were 3 (2.4%) re-operations involving anterior removal or revision surgery. Of note, there were no re-operations performed for fracture of vertebral bodies occurring during long-term follow-up.

DISCUSSION: The results of this study found that patients more than 60 years of age had statistically significant improvement in VAS and ODI scores. These results support that TDR can produce good outcomes in older patients without diminution of results with aging. Of note, there were no fractures occurring in long-term follow-up, which was originally a potential concern with these motion preserving implants. Older patients merit more detailed evaluation of possible calcification of vessels anterior to the spine and facet joints. If patients meet indications, they should not be excluded from TDR based only on age.