Assessing outcomes and recovery following anterior cervical discectomy and fusion in patients aged 75 years and older: a propensity score–matched review with 2-year follow-up

OBJECTIVE The longitudinal efficacy of anterior cervical discectomy and fusion (ACDF) in the population of older individuals is debated. The authors aimed to determine the long-term outcomes of patients aged ≥ 75 years compared to those of their younger peers. METHODS A prospectively collected quality registry of patients undergoing elective ACDF was retrospectively reviewed. Cohorts included patients who were ≥ 75 years compared to < 75 years of age. Patient-reported outcome measures (PROMs) were collected at baseline and 3, 12, and 24 months postoperatively. Demographics, surgical characteristics, complications, Eating Assessment Tool-10 (EAT-10) dysphagia rates, North American Spine Society satisfaction, and PROMs were compared between groups. All analyses were repeated following 1:1 propensity score matching by demographics, baseline PROMs, comorbidities, symptoms, and surgical factors. RESULTS A total of 1155 patients met inclusion criteria with 1082 (94%) aged < 75 years and 73 (6%) ≥ 75 years. Prior to propensity score matching, the ≥ 75-year cohort had a lower mean BMI (29.0 ± 4.3 vs 30.9 ± 6.6 kg/m 2 , p = 0.028), fewer daily smokers (4.1% vs 16%, p = 0.005), fewer currently employed workers (5.5% vs 52%, p < 0.001), and lower rates of anxiety (15% vs 28%, p = 0.017) and depression (12% vs 23%, p = 0.041). The ≥ 75-year cohort had more osteoarthritis (47% vs 24%, p < 0.001) and coronary artery disease (23% vs 6.5%, p < 0.001). The ≥ 75-year cohort had significantly better neck pain visual analog scale, arm pain visual analog scale (AP-VAS), Neck Disability Index, EuroQol 5-Dimension, and EuroQol visual analog scale baseline scores (all p < 0.05), but similar modified Japanese Orthopaedic Association scores (p = 0.2). By the 2-year follow-up, all PROM scores were similar except for the AP-VAS score, for which the ≥ 75-year cohort reported less arm pain (1.2 ± 2.5 vs 1.7 ± 2.7, p = 0.044). Propensity score matching yielded 138 patients, with 69 in each cohort. Residual demographic differences included the ≥ 75-year cohort having fewer employed workers (5.8% vs 42%, p < 0.001) and more individuals with a professional degree (25% vs 8.7%, p = 0.012). The propensity score–matched cohorts achieved parity in all baseline, postoperative, and change-from-baseline PROM scores through the 2-year follow-up. CONCLUSIONS Patients aged ≥ 75 years experience benefit comparable to that of younger patients across outcome measures following propensity score matching. Age alone does not predict worsened outcomes in carefully selected older patients undergoing elective ACDF, and older patients may benefit from knowledge of comparable favorable outcomes.