Introduction: Quoted complication rates in older patients range from 2.5–80% after surgical treatment of LSS. There is general disagreement whether operative therapy is riskier for older versus younger spines. Using comprehensive literature review and data from the international “Spine Tango” register (www.eurospine.org), this study examines the risk of surgery for LSS relative to age.

Methods: Between May 2005 and August 2009 20’794 patients with various spinal pathologies were documented. The current study applied the following inclusion criteria:

- lumbar or lumbosacral degenerative spinal stenosis

This produced 1,493 patients, who were subdivided into three age groups:

< 65 yrs (n=609, 41%),

Results: Over 80% of patient outcomes were scaled as good or excellent by the treating physician with no significant differences between the age groups.

The surgical complication rate in the complete sample was 5.7%. Multivariate logistic regression showed surgery time (p< 0.001), fusion/rigid stabilization (p=0.025) and age group (p=0.043) as a significant co-variates for surgical complications. Group 3 had a 2.1-times higher likelihood for a surgical complication as in group 1.

The general complication rate of the complete sample was 2.9%. We found ASA (p=0.002), fusion / rigid stabilization (p=0.022) and age group (p=0.008) as significant influencing factors for general complications.

The follow-up complication rate was 10.2% and did not vary significantly between age groups, but multivariate logistic regression showed fusion/rigid stabilization (p< 0.001) and previous surgery (p=0.005) to be significant co-variates for FU complications.

Clearly age-related was the duration of hospital admission and level of ASA (both p< 0.001).

Discussion: The outcomes found in the “Spine Tango” register indicate that both surgical and general (particularly cardiovascular and urinary tract infections) complication rates after decompression for LSS are negatively influenced by age. The complication rates at FU showed no age-related variation, and according literature re-operation rates after surgery of the lumbar spine appear to actually decrease with aging.

Our study and literature leaves no doubt about that aged and very aged patients benefit from surgical treatment. Therefore, although we should be aware of the increased risk for surgical and general complications in this population, high age (> 75 yrs) should not be a main influencing factor in the choice of operative indication and strategy when treating LSS.

Aims: In this study, the subsidence of different interbody fusion devices was investigated. Hereby, the influence of different designs as well as of the preparation technique was evaluated. Methods: 3 common cervical interbody fusion devices (BAK, Novus and WING) underwent axial compression testing with 4000 cycles in a bovine spine model. The vertebral bodies were prepared in 3 different ways, taking away 0, 1 and 2 mm of the end-plate. So each fusion device was tested in each preparation group in 5 vertebrae. Every 1000 cycles, the subsidance was measured. Results: Taking away 1 and 2 mm of the endplate resulted in a strong increase of the subsidance compared to the situation with intact end-plate. In addition, the design of the interbody device had an influence onto subsidance: In case of intact endplates, the cages with rectangular supporting areas resisted better to axial compression than the cylindrical implant. When the cortical bone of the endplate was taken away, all three implants showed similar subsidance curves. Conclusions: Implants with plane supports seem to provide better stability against subsidance than cylindrical implants. During preparation, the cortical structure of the endplate should be taken care of, especially in the zone, where the implant has its bearing areas