Elderly Patients Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion May Have Similar Clinical Outcomes, Perioperative Complications, and Fusion Rates As Their Younger Counterparts

Abstract

Background Although several studies have suggested that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) may be especially beneficial in the elderly population due to lower operative morbidity and faster postoperative recovery, there are limited studies investigating the functional outcomes, quality of life, and satisfaction in elderly patients after MIS-TLIF. Furthermore, existing studies had substantial clinical, diagnostic, and surgical heterogeneity. Questions/purposes We asked if elderly patients could experience comparable (1) patient-reported pain, disability and quality of life, (2) perioperative complications, and (3) radiological fusion rates as their younger counterparts after MIS-TLIF. Methods Prospectively collected registry data of patients undergoing primary, single-level, MIS-TLIF for degenerative spondylolisthesis between 2012 and 2014 were reviewed. We included 168 patients, 39 of whom were at least 70 years old. Of the 129 patients younger than 70 years old, propensity-score matching was used to select 39 younger controls with adjustment for sex, BMI, American Society of Anesthesiologists score, and baseline clinical outcomes. Perioperative complications and radiologic data were compared. Results There was no difference in back pain (mean difference -0.3 [95% confidence interval -1.0 to 0.5]; p = 0.52); leg pain (mean difference -0.1 [95% CI to 0.6-0.5]; p = 0.85); Oswestry Disability Index (mean difference -2.9 [95% CI -8.0 to 2.2]; p = 0.26); and SF-36 physical (mean difference 3.0 [95% CI -0.7 to 6.8]; p = 0.107); and mental component summary (mean difference 1.9 [95% CI -4.5 to 8.2]; p = 0.56); up to 2 years postoperatively; 85% of younger patients and 85% of elderly patients were satisfied (p > 0.99) while 87% and 80%, respectively, had fulfilled expectations (p = 0.36). Four perioperative adverse events occurred in each group. There was also no difference in the rate of fusion (87% in younger patients and 90% in elderly patients; p = 0.135). Conclusions When clinical and surgical heterogeneity were minimized, elderly patients undergoing minimally invasive transforaminal lumbar interbody fusion not only had comparable rates of perioperative complications but also experienced similar improvements in pain, function, and quality of life. A high rate of satisfaction was achieved. Level of Evidence Level II, prognostic study.

Advanced Age Does Not Impact Outcomes After 1-level or 2-level Lateral Lumbar Interbody Fusion

“…Our study also found that increasing age was associated with decreased LOS. This finding runs counter to previous studies, which have demonstrated longer LOS with increased age, though these studies include other surgical approaches 10,27,28. In addition, other reports have found the decreased LOS with increased age in certain orthopedic procedures 29,30.…”

“…8 Recent studies of minimally invasive transforaminal lumbar fusion (MIS-TLIF) demonstrate that elderly patients experience outcomes and complications similar to those of younger patients. 9,10 Lateral lumbar interbody fusion (LLIF) is another minimally invasive technique that allows smaller incisions and minimizes the soft tissue trauma associated with posterior approaches and the risk of vascular injury associated with anterior approaches. [11][12][13] This technique generally includes unilateral percutaneous screw or lateral plate fixation but can also be performed with standalone implants.…”

Systematic review and meta-analysis of the therapeutic effects of minimally invasive transforaminal interbody fusion on spondylolisthesis

“…The complication rate difference between MI-TLIF and O-TLIF was also statistically significant [OR =0.48, 95% CI: (0.30, 0.76), P=0.002], and compared with O-TLIF, MI-TLIF could reduce the incidence of complications. The occurrence of complications may be related to factors such as the technological difficulties of minimally invasive surgery and the long learning curve (20,21).…”

Understanding the Future Prospects of Synergizing Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery with Ceramics and Regenerative Cellular Therapies

“…The low and high levels of these indices indicate early and delayed return to work, respectively [ 68 ]. Interestingly, similar clinical outcomes (improvements in pain, function, and life quality), perioperative complications, fusion rates, and safety of MIS-TLIF have also been reported between elderly and young patients [ 69 ]. Based on the above evidence, it could be inferred that MIS-TLIF is an effective surgical intervention over other possible TLIF in providing long-term relief.…”

“…However, older patients experienced much longer time in body movement and hospitalization with comparatively lesser improvement in ODI and SF-36 physical function scores, although the NASS, VAS, and SF-36 mental scores were equivalent among both age groups. A prospective study also mentioned no observed significant difference in pain (back and leg), ODI, SF-36 score, as well as fusion rate among aged and young patient groups two years post-surgery [ 69 ]. When clinical and surgical differences were minimized, the MIS-TLIF seemed equally effective for aged patients without any considerable post-operative complexity.…”