Complication rate during multilevel lumbar fusion in patients above 60 years

Abstract

Background:Spine surgery in elderly with comorbidities is reported to have higher complication rates and increased cost. However, the surgical outcome is good irrespective of the complications. Hence, it is essential to identify the factors affecting the complication rates in such patients and the measures to reduce them. This retrospective observational study determines the perioperative complications, their incidence and the measures to reduce complications in the elderly with comorbidities, operated by instrumented multilevel lumbar fusion.Materials and Methods:Patients aged 60 years and above with one or more comorbidities operated by multilevel instrumented lumbar fusion in our center between January 2012 and December 2013 were included in the study. Perioperative complications and their incidence were calculated. Age, number of levels fused, operative time, blood loss, and complication rates were correlated with the duration of stay and the incidence of perioperative complications using SPSS software. Measures to reduce complications are determined by these results and by review of literature.Results:Fifty two patients were included in the study (28 females and 24 males) with an average age of 69 years (range 60-84 years). Hypertension was the most common comorbidity followed by diabetes. Spondylolisthesis was the most common indication. Eleven complications were noted with an incidence of 21%. Three were systemic complications which required transfer to Intensive Care Unit. Local complications were incidental durotomy (three), transient root deficits (two), wound infections (one), and persistent radicular pain (two). Operative time and blood loss were significantly higher in patients with complications.Conclusion:Complication rates strongly correlate with the blood loss and operative time. Reducing the operative time and blood loss by intraoperative tranexamic acid, laminectomy using osteotome, simultaneous bilateral exposure and instrumentation and reducing the number of interbody fusions can help in reducing the complications.

Comparison of Different Approaches in Lumbosacral Spinal Fusion Surgery: A Systematic Review and Meta-Analysis

“…In line with previous findings, the reported risk factors of PLIF such as fixation of multiple levels, longer operations, and non-union have shown a positive link between these factors and complication rates [ 45 ]. Continuous bleeding from the operation site while proceeding at other levels was one reason for the increased rate of complications associated with longer surgeries [ 45 ]. In aspects of cage placement, smaller cages increase the likelihood of posterior cage migration, which was also corroborated by previous findings.…”

Predictive nomogram of cage nonunion after anterior cervical discectomy and fusion: A retrospective study in a spine surgery center

“…Vijay et al determined that lower vitamin D level played an important role in a lower rate of and a longer time to fusion. [ 29 , 30 ] In our study, we also found that serum vitamin D (OR = 0.79, P < .001) was significant predictor of nonunion. These findings indicate it is necessary to proceed a prospective study to analyze the role of vitamin D supplementation on spinal fusion.…”

Demineralized Bone Matrix Fibers plus Allograft Bone for Multilevel Posterolateral Spine Fusion: A Game Changer?

“…The complication rate is higher following multilevel fusion due to longer operative time, more intraoperative blood loss and requirement for additional bone graft, especially in older patients [13]. There were no intraoperative or postoperative complications in our study where the patients ranged in age from 16 to 69 years.…”