Article
Outcome of posterior lumbar fusion surgery for spondylolisthesis and spinal stenosis in the octogenarian population
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Authors
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Jürgen-Volker Anton
- Universitätsklinik für Neurochirurgie, Paracelsus Medizinische Privatuniversität Salzburg, Austria
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Santino Ottavio Tomasi
- Universitätsklinik für Neurochirurgie, Paracelsus Medizinische Privatuniversität Salzburg, Austria
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Martin Krombholz
- Universitätsklinik für Neurochirurgie, Paracelsus Medizinische Privatuniversität Salzburg, Austria
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Peter A. Winkler
- Universitätsklinik für Neurochirurgie, Paracelsus Medizinische Privatuniversität Salzburg, Austria
| Published: | June 8, 2016 |
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Outline
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Objective: The present study analyses the results after de-novo lumbar fusion surgery for patients in their ninth decade of life
Method: Between January 2010 and September 2013 de novo posterior lumbar fusion was performed in 46 patients (27 women, 19 men, median age 82, range 80-86 years). The department of internal and geriatric medicine examined all patients. The indication for surgical treatment (Posterior Lumbar Interbody Fusion, PLIF) was at least 6 months lasting spinal claudication not responding to conservative treatment and resulting in reduced walking ability up to immobilisation syndrome. We retrospectively reviewed perioperative morbidity, mortality, length of operation, postoperative neurological status, preoperative comorbidities, need for revision surgery and outcome after 12 months.
Results: 38 Patients had to be treated with monosegmental fusion. 8 patients underwent bisegmental lumbar fusion. We found 1 to 7 comorbidities preoperatively. 13 patients (28%) experienced complications. After onset of anaesthesia the need for suprapubic catheter occurred in one patient. Intraoperative complications included one aortal perforation and one dural laceration. Perioperative surgical morbidity (13%) included screw loosening and screw dislocation, cage dislocation, rebleeding, wound dehiscence and adjacent segmental disease. Postoperative neurological deterioration occurred in two patients. Two patients experienced temporary medical complications were experienced by two patients. Postoperatively, one patient died at the intensive care unit (Perioperative mortality 2%). Revision surgery had to be performed in 6 patients (13%). After 12 months 11 patients (23%) showed an excellent outcome (full mobility, no spinal claudication). Good outcome (improved walking distance without pain) could be seen in 24 (52%) patients. 4 patients (9%) had a moderate outcome (3 points less pain on Visual Analogue Scale, need for pain medication). 7 patients (15%) experienced a bad outcome (less pain reduction, need for revision surgery).
Conclusions: Instrumented lumbar fusion surgery in the octogenarian population represents an enormous challenge. Perioperative surgical morbidity is linked with need for revision surgery and worse long-term results. Nevertheless, carefully selected patients with spondylolisthesis and spinal stenosis profit from instrumented lumbar fusion surgery in their ninth decade of life.
