Instrumented intervertebral or posterolateral fusion in elderly patients Clinical results of a single center

Abstract

BackgroundData on the clinical outcome after spinal fusion in the elderly patient are rare. To our knowledge there has been no clinical outcome assessment for instrumented spinal fusion in elderly patients comparing posterolateral fusion with intervertebral fusion. Aim of the current study was to evaluate the clinical outcome of elderly patients who underwent a spinal fusion procedure for degenerative spinal stenosis with instability. Main hypothesis was to test whether it is necessary to force an intervertebral fusion for a better clinical outcome in spinal fusion surgery of the elderly or not.MethodsTwo subgroups - posterolateral fusion versus intervertebral fusion (cage vs. non-cage) were compared with regard to functional outcome, fusion rates and complications after a mean follow up of 3.8 years. Questionnaires were completed by the patients before surgery and at final follow-up. Changes in mean VAS and ODI scores (decrease from the baseline VAS and ODI scores) were compared.ResultsThe mean final follow up for all subjects was 3.8 years. Of the 114 patients, 2 patients were deceased at the time of the follow-up, 5 patients didn't want to participate and 107 patients completed the questionnaires. This resulted in an overall follow-up rate of 93%. At final follow-up, the patients demonstrated significant improvement in the VAS and ODI- compared with the preoperative scores in both groups. But overall there were no significant differences between both groups regarding the outcome assessment using the ODI and VAS.ConclusionsThe results of this study shows that elderly patients aged over 75 benefit from instrumented lumbar fusion. The study suggests that there is no need to force an intervertebral fusion because elderly patients do not seem to benefit from this procedure.

Instrumented fusion surgery in elderly patients (over 75 years old): clinical and radiological results in a series of 53 patients

“…Although in the literature there are no conclusive studies conducted on elderly patients, good clinical results are described with improvements both in VAS and ODI of 45 and 27 %, respectively [2,3,6,15,16]. Our results are inline with published data, with a significant score improvement both on VAS and ODI, at the latest check.…”

“…Although the necessity to perform elective surgical procedures for the over 75-year-old patients is still under debate, surgeons are required to solve the daily contention between increasing demands on the quality life and the technical problem/morbidity related with instrumented surgery. To date, there are little data on the clinical and radiological outcome following spinal fixation and fusion in elderly patients and the studies present some limitations, mainly due to small populations and the use of heterogeneous evaluation tools [6][7][8].…”

Posterior Instrumented Spinal Surgery Outcomes in the Elderly: A Comparison of the 5-Item and 11-Item Modified Frailty Indices

“…30 In evaluating this conflicting evidence, Endres et al summarized these findings to contend that spinal instrumented surgery, in the appropriately selected cohort of non-frail elderly patients, has a measurable benefit. 6 , 7 , 23 , 27 , 31 In other words, a preoperative risk stratification instrument which accurately encapsulates the frailty status of an elderly patient is desperately needed. Ironically, the essence of frailty has long been intuitively appraised by clinicians by the bedside either consciously or unconsciously.…”