A recently published article in the online first section of the Asian Spine Journal titled “Perioperative complications in patients aged ≥85 years undergoing spinal surgery: a retrospective comparative study of pre-old and old patients in Japan” caught my attention [1]. The authors presented valuable insights into the perioperative challenges faced by elderly patients undergoing spinal surgery, with a particular focus on comparing pre-old and old populations. The authors have excellently emphasized the significance of identifying age-related risk factors in surgical decision-making. The thorough investigation of preoperative factors, including comorbidities and functional status, is praiseworthy.

While the article is comprehensive, I would like to focus on a few additional points that could be of importance for further research and clinical practice.

Long-term outcomes are particularly important for the older patients [2]. The examination of long-term outcomes could be of importance for both the pre-old and old patient groups, particularly for mobility, quality of life, and functional independence. Future studies could enhance postoperative outcomes in elderly patients of spine surgery by executing long-term follow-up protocols via electronic health records, mobile health applications, and use of patient-reported outcome measures [3,4]. Integrating real-world data, and ensuring regular assessments could provide understandings of recovery trends and guide tailored healthcare approaches.

Owing to the complex nature of spinal surgeries in elderly patients, it would be valuable to explore the role of a multidisciplinary care team including geriatrics specialists, anesthesiologists, and rehabilitation specialists to provide a more holistic view of perioperative care and possibly reduce complications. There is evidence that pre-surgery physiotherapy may enhance self-management through increased confidence, improved knowledge, and awareness [5]. There is evidence that effective multidisciplinary teams are essential for successful comprehensive geriatric assessment and creating and enhancing high performing teams should be a main concern in healthcare for older people [6].

The integration of artificial intelligence (AI)-driven predictive models could be an interesting area seems promising in spine surgery of elderly patients. These models could help in risk stratification, enabling more custom-made treatment plans that could affect variables such as frailty and cognitive status [7]. AI-based approaches in spine surgery can help to improve the accuracy currently reported using statistical modelling [8].

There is scarcity of exploration of cultural and societal factors that can influence the management and outcomes of spinal surgeries in elderly patients. Social determinants of health are factors that affect patient health outcomes outside the hospital [9]. Factors such as social support, family involvement, and patient expectations may play a significant role in both recovery and long-term outcomes. Formulating a precise plan for obtaining help with the participation of family or friends, may also improve pre-surgery planning for rehabilitation after surgical procedure among elder adults [10]. Spine surgeons should consider social determinants of health factors more when treating patients [9].

The authors have presented valuable information that will be helpful in improving perioperative care for elderly patients undergoing spinal surgery. This article will serve as a valuable resource for practitioners in geriatric medicine and spinal surgery.