Individuals Over 75 Year Old Experience Greater Revisions Following Transforaminal Lumbar Interbody Fusion (TLIF): A Propensity Matched Study

Study Design Retrospective cohort study. Objective To evaluate the impact of age ≥75 years on postoperative complications and sagittal alignment following open transforaminal lumbar interbody fusion (TLIF). Methods A retrospective review was performed for patients undergoing primary open TLIF from 2017 to 2021. Patients were divided into 2 cohorts: age <75 and ≥75 years. Groups were 1:1 propensity score matched based on gender, body mass index (BMI), hypertension, diabetes, and Charlson Comorbidity Index (CCI). Radiographic sagittal parameters were analyzed preoperatively and at 1 year postoperatively. Complication rates, including reoperations, adjacent segment disease, and subsidence, were compared between matched cohorts. Results Prior to the PSM, a total of 489 patients fit the initial exclusion criteria with 448 in the younger (18-75 years) cohort and 40 in the older (≥75 years) cohort. After matching, 80 patients were included (40 per group) with no significant differences in demographics or perioperative variables. Postoperative radiographic parameters were similar between groups. The overall complication rates were comparable ( P = 0.546). However, elderly patients experienced significantly higher rates of revision surgery (27.5% vs 5.7%, P = 0.013). Conclusion Patients ≥75 years old achieved similar radiographic alignment and experienced comparable complication rates following open TLIF. However, they may be at greater risk for revision surgery. These findings support the safety and effectiveness of open TLIF in elderly patients, though larger and longer-term studies are needed to further define outcomes in this population. Level of Evidence III.