gms | German Medical Science

Objective: Geriatric patients represent an important part of degenerative spine cases in the daily surgical routine. Aim of this study was to assess neurological outcome, medical comorbidities and surgery related/medical complications after lumbar dorsal instrumentation in octogenarians.

Method: 80 pats. (35 m /45 f, mean age 83 yrs, 80-91) > 80 years who underwent lumbar dorsal instrumentation between 03/2008 and 06/2013 were retrospectively assessed. Age at surgery, neurological status, medical comorbidities, complications, duration of surgery, postoperative Barthel index, length of hospital stay and rate of revision surgeries were recorded.

Results: 77 pats. (96%) had a mean of 2 (1-6) relevant medical disorders. Mean duration of preoperative symptoms was 26 ± 56 months (1-360). Mean duration of surgery was 3 ± 0.05 hrs (1.05-7.29). 21 pats. received mono-, 59 multisegmental instrumentations (2-7 levels) and 14 dorsoventral fusions. 31 pats. had at least one previous surgery at the index level. 27 (33.8%) pats. suffered from preoperative neurological deficits, 8/27 (29.6%) improved postoperatively, 17/27 (63%) were unchanged and 2/27 (7.4%) worsened. New neurological deficites were seen in 2/80 (2.5%), 1 transient, 1 permanent. 25 mild intraoperative complications occurred: 18 durotomies and 7 intraoperative screw revisions. 14 (17.5%) pats. experienced postoperative surgery related complications with need for revision surgery in 11 (13.8%): 3 wound infections, 3 haematomas, 3 screw/cage dislocations, 2 CSF leaks, 1 spondylodiscitis, 1 epidural cement leak,1 spinal ischemia of unknown etiology. 57 postoperative medical complications were reported in 39 (48.8%) pats. 5 (6.25%) of them needed ICU treatment (mean ICU stay 14.6d ± 12.2, 2-33). 3 deaths were reported due to renal failure (1), pneumonia, cardiac arrhythmia (1) and 1 tumor related. Mean postoperative Barthel index was 49.5 ± 23.4 (5-100), mean length of hospitalization 16.2 d ± 12.1 (3-60).

Conclusions: Dorsal lumbar instrumentation is associated with a relatively high rate of surgical (17.5%) and medical complications (48.8%). Considering the high age and preoperative medical disorders the rates of surgery related (8.8%) or postoperative medical complications (6.25%) were moderate. Careful patient selection, stringent surgical indications and thorough medical monitoring are required to improve safety of surgical procedures and reduce the risk of peri- and postoperative complications.