Study Design: Retrospective study of registry data. Objectives: Aging of society and recent advances in surgical techniques and general anesthesia have increased the demand for spinal surgery in elderly patients. Many complications have been described in elderly patients, but a multicenter study of perioperative complications in spinal surgery in patients aged 80 years or older has not been reported. Therefore, the goal of the study was to analyze complications associated with spine surgery in patients aged 80 years or older with cervical, thoracic, or lumbar lesions. Methods: A multicenter study was performed in patients aged 80 years or older who underwent 262 spinal surgeries at 35 facilities. The frequency and severity of complications were examined for perioperative complications, including intraoperative and postoperative complications, and for major postoperative complications that were potentially life threatening, required reoperation in the perioperative period, or left a permanent injury. Results: Perioperative complications occurred in 75 of the 262 surgeries (29%) and 33 were major complications (13%). In multivariate logistic regression, age over 85 years (hazard ratio [HR] = 1.007, P = 0.025) and estimated blood loss ≥500 g (HR = 3.076, P = .004) were significantly associated with perioperative complications, and an operative time ≥180 min (HR = 2.78, P = .007) was significantly associated with major complications. Conclusions: Elderly patients aged 80 years or older with comorbidities are at higher risk for complications. Increased surgical invasion, and particularly a long operative time, can cause serious complications that may be life threatening. Therefore, careful decisions are required with regard to the surgical indication and procedure in elderly patients.

Study Design.: Retrospective analysis of consecutive 45 radiographs and 120 kinematic magnetic resonance images (kMRI) Objective.: The aim was to assess the visibility of C7 and T1 endplates on radiographs, and to verify the correlation between C7 or T1 slope and cervical balance parameters using kMRI. Summary of Background Data.: Because the T1 slope is not always visible due to the anatomical interference, several studies have used C7 slope instead of T1. However, it is still unclear whether the C7 endplate is more visible on radiographs than T1, and if C7 slope has similarity with T1 slope. Methods.: The endplate visibility was determined using weight-bearing radiography. Subsequently, using weight-bearing MR images, the C7 slope of upper and lower endplate, T1 slope, C1 inclination, C2 slope, atlas-dens interval (ADI), C2–C7 lordotic angle, cervical sagittal vertical axis (cSVA), cervical tilt, cranial tilt, neck tilt, thoracic inlet angle (TIA) were measured, for the analysis of correlation between three types of slopes and cervical balance parameters. Results.: 82% of the upper C7, and 18% of T1 endplate were clearly visible. The upper C7 endplate was significantly visible, whereas T1 endplate was significantly invisible (residual analysis, P < 0.01). Linear regression analysis showed correlation between the upper C7 slope and T1 slope (R ² = 0.818, P < 0.01) and, lower C7 slope and T1 slope (R ² = 0.840, P < 0.01). T1 slope significantly correlated with neck tilt, TIA, C2–C7 angle, cSVA, cervical and cranial tilt, but not with the C1 inclination, C2 slope, and ADI. Upper and lower C7 slopes showed the close resemblance with T1 slope in terms of correlation with those parameters. Conclusion.: Both, upper and lower C7 slope correlated strongly with T1 slope and showed similar relationship with cervical balance parameters as T1 slope. Therefore, C7 slope could potentially substitute T1 slope, especially upper C7 slope due to the good visibility. Level of Evidence: 3

Study Design: Retrospective database analysis. Objective: Spine surgeries in elderly patients have increased in recent years due to aging of society and recent advances in surgical techniques, and postoperative complications have become more of a concern. Postoperative delirium is a common complication in elderly patients that impairs recovery and increases morbidity and mortality. The objective of the study was to analyze postoperative delirium associated with spine surgery in patients aged 80 years or older with cervical, thoracic, and lumbar lesions. Methods: A retrospective multicenter study was performed in 262 patients 80 years of age or older who underwent spine surgeries at 35 facilities. Postoperative complications, incidence of postoperative delirium, and hazard ratios of patient-specific and surgical risk factors were examined. Results: Postoperative complications occurred in 59 of the 262 spine surgeries (23%). Postoperative delirium was the most frequent complication, occurring in 15 of 262 patients (5.7%), and was significantly associated with hypertension, cerebrovascular disease, cervical lesion surgery, and greater estimated blood loss ( P < .05). In multivariate logistic regression using perioperative factors, cervical lesion surgery (odds ratio = 4.27, P < .05) and estimated blood loss ≥300 mL (odds ratio = 4.52, P < .05) were significantly associated with postoperative delirium. Conclusions: Cervical lesion surgery and greater blood loss were perioperative risk factors for delirium in extremely elderly patients after spine surgery. Hypertension and cerebrovascular disease were significant risk factors for postoperative delirium, and careful management is required for patients with such risk factors.