Article
Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF): perioperative and postoperative complications in patients aged 80 to 90 years
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Authors
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Jan-Helge Klingler
- Klinik für Neurochirurgie, Universitätsklinikum Freiburg, Freiburg
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Marie T. Krüger
- Klinik für Neurochirurgie, Universitätsklinikum Freiburg, Freiburg
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Christoph Scholz
- Klinik für Neurochirurgie, Universitätsklinikum Freiburg, Freiburg
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Roland Rölz
- Klinik für Neurochirurgie, Universitätsklinikum Freiburg, Freiburg
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Ronen Sircar
- Klinik für Neurochirurgie, Universitätsklinikum Freiburg, Freiburg
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Ulrich Hubbe
- Klinik für Neurochirurgie, Universitätsklinikum Freiburg, Freiburg
| Published: | June 2, 2015 |
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Outline
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Objective: This study was intended to identify perioperative and postoperative complications in patients aged 80 to 90 years who have undergone minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).
Method: This retrospective monocentric study implies 21 consecutive patients aged 80 to 90 years who underwent MIS TLIF due to instability and degenerative disease between March 2009 and February 2014. Hospital records were reviewed for patient demographics including body mass index and preoperative comorbidities, procedures, and perioperative and postoperative complications within 30 days of surgery.
Results: Mean age was 84.1 ± 2.7 years, body mass index was 25.7 ± 2.9 kg/m2. All patients had preoperative comorbidities. 31 levels of MIS TLIF had been performed in 21 patients (1.5 MIS TLIF/patient). 10/21 patients (47%) had previous decompression surgery in at least one of the fusion levels. Simultaneous decompression of the spinal canal in the fusion level was necessary in 16/21 patients (76%). Five additional adjacent levels had been decompressed without fusion. Additional cement augmentation of the screws due to osteoporosis was performed in 11/21 patients (52%). Mean surgical time was 247 ± 97 min. Postoperative length of stay was 8.3 ± 2.7 days. Within 30 days of surgery, 7/21 patients (33%) experienced neither major nor minor complications. The remaining 14/21 patients (67%) had 6 major and 24 minor complications. Two of these patients died within 30 days of surgery due to sepsis and pulmonary embolism (mortality 9.5%).
Conclusions: Even if performing MIS TLIF in patients aged 80 to 90 years is technically feasible, spine surgeons have to be aware that these old patients are at an increased risk for perioperative and postoperative complications. We recommend to offer MIS TLIF to a patient in this age group only if conservative therapy had failed and the patient complains of a very high level of suffering. Moreover, the estimated benefit of surgery has to outweigh the risk of surgery. Therefore, careful patient selection and anesthesiological assessment is mandatory to minimize perioperative morbidity and mortality in patients in this age group fraught with risk.
