gms | German Medical Science

Objective: The number of geriatric patients with complex degenerative lumbar spinal disorders is increasing. There is limited knowledge about complications rates in those who had fusion surgery for instability and chronic pain. Here, we evaluated the frequency of complications within 30 days postoperatively in patients with 75 years of age and older who underwent lumbar spinal fusion surgery over a period of 13 years.

Method: Eighty two patients who were 75 years of age or older and underwent lumbar fixation and arthrodesis were analyzed for this retrospective study. Medical and surgical records were reviewed and all complications which occurred within 30-day morbidity were recorded.

Results: Patients had a mean age of 78 years (range, 75-87 years). There were 56 women and 26 men. Seventy eight patients (95%) had a history of previous lumbar spine surgery. Twenty nine patients underwent fusion for 1 level, 36 for 2 levels, 8 for 3 levels, 6 for 4 levels, 2 for 5 levels, and 1 for 6 levels. There were no deaths. Twenty three patients (28%) had at least 1 perioperative complication, and 10 patients (12%) had at least one major complication (deep wound infections, pneumonia, renal failure, myocardial infarction, congestive heart failure, respiratory distress, epidural hematoma, gastrointestinal hemorrhage, pulmonary embolus, neurological deficit). The most common major complication was deep wound infection in 6 patients (7%). The complication rate increased with older age and comorbidities.

Conclusions: Despite the beneficial effect, elderly patients are at increased risk for surgical complications because of their age and comorbidities. Good preoperative clinical judgment and diligent selection of geriatric patients is essential to avoid increased rates of morbidity in lumbar spinal fusion surgery.