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Perioperative Results and Complications after Posterior Lumbar Interbody Fusion for Spinal Stenosis in Geriatric Patients over than 70 Years Old

  • Choi, Jong Min (Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine) ;
  • Choi, Man Kyu (Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine) ;
  • Kim, Sung Bum (Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine)
  • 투고 : 2017.07.04
  • 심사 : 2017.08.16
  • 발행 : 2017.11.01

초록

Objective : As increasing the size of the geriatric population, the number of elderly patients, who need the surgery for painful degenerative spinal stenosis has been increasing. The geriatric population may be relatively high complications, because of age and age-associated medical conditions. However, there is a lack of studies addressing the perioperative complications and outcomes in elderly patients with posterior lumbar inter body fusion with screw augmentation (PLIF). Methods : We retrospectively reviewed the medical records and radiographic studies of geriatric patients who had spine surgery of PLIF due to spinal stenosis for 11 years. We divided into 2 groups (A; 70-75 years, B; over then 76 years) according to the age. Surgical level of each groups, hospital day and postoperative day, co-morbidities, complications, clinical outcomes were analyzed. Operative reports, hospital and outpatient clinic charts, and radiographic studies were reviewed. Results : Group A was composed of 80 patients, their mean age was 72.21 and female dominant (n=46), and their mean surgically fused level was 1.52 level. Group B was 36 patients, their mean age was 78.83 and female dominant (n=20), and their mean surgically fused level was 1.36 level. Comparing between two groups, complications, postoperative hospital stay were slightly increase in group B and co-morbidity was statistically high in group B, however clinical outcomes were similar between two groups. Conclusion : Increasing age might be an important risk factor for complications in patients undergoing PLIF, however, we would like to recommend that if the situation of spine of extreme geriatric patients need PLIF, it should be in the surgeon's consideration after careful selection and clinical judgement.

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참고문헌

  1. Brown CH 4th, LaFlam A, Max L, Wyrobek J, Neufeld KJ, Kebaish KM : Delirium after spine surgery in older adults: incidence, risk factors, and outcomes. J Am Geriatr Soc 64 : 2101-2108, 2016 https://doi.org/10.1111/jgs.14434
  2. Burkus JK, Foley K, Haid RW, LeHuec JC : Surgical interbody research group--radiographic assessment of interbody fusion devices: Fusion criteria for anterior lumbar interbody surgery. Neurosurg Focus 10 : E11, 2001
  3. Cassinelli E, Eubanks J, Vogt M, Furey C, Yoo J, Bohlman HH : Risk factors for the development of perioperative complications in elderly patients undergoing lumbar decompression and arthrodesis for spinal stenosis. SPINE (Phila Pa 1976) 32 : 230-235, 2006
  4. Caputy A, Spence CA, Bejjani GK, Luessenhop AJ : The role of spinal fusion in surgery for lumbar spinal stenosis: a review. Neurosurg Focus 3 : e3, 1997
  5. Caputy AJ, Luessenhop AJ : Long-term evaluation of decompressive surgery for degenerative lumbar stenosis. J Neurosurg 77 : 669-676, 1992 https://doi.org/10.3171/jns.1992.77.5.0669
  6. Cho KJ, Suk SI, Park SR, Kim JH, Kim SS, Choi WK, et al. : Complications in posterior fusion and instrumentation for degenerative lumbar scoliosis. SPINE (Phila Pa 1976) 32 : 2232-2237, 2007 https://doi.org/10.1097/BRS.0b013e31814b2d3c
  7. Choma T, Rechtine GR, McGuire RA Jr, Brodke DS : Treating the aging spine. J Am Acad Orthop Surg 23 : e91-e100, 2015 https://doi.org/10.5435/JAAOS-D-15-00245
  8. Cloyd J, Acosta FL Jr, Ames CP : Complications and outcomes of lumbar spine surgery in elderly people: a review of the literature. J Am Geriatr Soc 56 : 1318-1327, 2008 https://doi.org/10.1111/j.1532-5415.2008.01771.x
  9. Cloyd J, Acosta FL Jr, Cloyd C, Ames CP : Effects of age on perioperative complications of extensive multilevel thoracolumbar spinal fusion surgery. J Neurosurg Spine 12 : 402-408, 2010 https://doi.org/10.3171/2009.10.SPINE08741
  10. Coric D, Branch CL Jr : Posterior lumbar interbody fusion in the treatment of symptomatic spinal stenosis. Neurosurg Focus 3 : e5, 1997
  11. Dagistan Y, Dagistan E, Gezici AR, Cancan SE, Bilgi M, Cakir U : Effects of minimally invasive decompression surgery on quality of life in older patients with spinal stenosis. Clin Neurol Neurosurg 139 : 86-90, 2015 https://doi.org/10.1016/j.clineuro.2015.09.009
  12. Daubs M, Lenke LG, Cheh G, Stobbs G, Bridwell KH : Adult spinal deformity surgery: complications and outcomes in patients over age 60. Spine (Phila Pa 1976) 32 : 2238-2244, 2007 https://doi.org/10.1097/BRS.0b013e31814cf24a
  13. Deyo RA, Cherkin DC, Loeser JD, Bigos SJ, Ciol MA : Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure. J Bone Joint Surg Am 74 : 536-543, 1992 https://doi.org/10.2106/00004623-199274040-00009
  14. Dipierro CG, Helm GA, Shaffrey CI, Chadduck JB, Henson SL, Malik JM : Treatment of lumbar spinal stenosis by extensive unilateral decompression and contralateral autologous bone fusion: operative technique and results. J Neurosurg 84 : 166-173, 1996 https://doi.org/10.3171/jns.1996.84.2.0166
  15. Epstein NE : Surgical management of lumbar stenosis: decompression and indications for fusion. Neurosurg Focus 3 : e1; discussion 1 p following e4, 1997
  16. Fehlings M, Tetreault L, Nater A, Choma T, Harrop J, Mroz T, et al. : The aging of the global population: the changing epidemiology of disease and spinal disorders. Neurosurgery 77 Suppl 4 : S1-S5, 2015 https://doi.org/10.1227/NEU.0000000000000953
  17. Fox MW, Onofrio BM, Onofrio BM, Hanssen AD : Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone. J Neurosurg 85 : 793-802, 1996 https://doi.org/10.3171/jns.1996.85.5.0793
  18. Fox MW, Onofrio BM : Indications for fusion following decompression for lumbar spinal stenosis. Neurosurg Focus 3 : e2; discussion 1 p following e4, 1997
  19. Forsth P, Michaelsson K, Sanden B : Does fusion improve the outcome after decompressive surgery for lumbar spinal stenosis?: a two-year follow-up study involving 5390 patients. Bone Joint J 95 : 960-965, 2013
  20. Galarza M, Fabrizi AP, Maina R, Gazzeri R, Martinez-Lage JF : Degenerative lumbar spinal stenosis with neurogenic intermittent claudication and treatment with the aperius perclid system: a preliminary report. Neurosurg Focus 28 : E3, 2010
  21. Glassman SD, Alegre G, Carreon L, Dimar JR, Johnson JR : Perioperative complications of lumbar instrumentation and fusion in patients with diabetes mellitus. Spine J 3 : 496-501, 2003 https://doi.org/10.1016/S1529-9430(03)00426-1
  22. Glassman SD, Carreon LY, Dimar JR, Campbell MJ, Puno RM, Johnson JR : Clinical outcomes in older patients after posterolateral lumbar fusion. Spine J 7 : 547-551, 2007 https://doi.org/10.1016/j.spinee.2006.11.003
  23. Gruskay JA, Fu M, Bohl DD, Webb ML, Grauer JN : Factors affecting length of stay after elective posterior lumbar spine surgery: a multivariate analysis. Spine J 15 : 1188-1195, 2015 https://doi.org/10.1016/j.spinee.2013.10.022
  24. Hudak EM, Perry MW : Outpatient minimally invasive spine surgery using endoscopy for the treatment of lumbar spinal stenosis among obese patients. J Orthop 12 : 156-159, 2015 https://doi.org/10.1016/j.jor.2015.01.007
  25. Kilincer C, Steinmetz MP, Sohn MJ, Benzel EC, Bingaman W : Effects of age on the perioperative characteristics and short-term outcome of posterior lumbar fusion surgery. J Neurosurg: Spine 3 : 34-39, 2005 https://doi.org/10.3171/spi.2005.3.1.0034
  26. Lee JH, Chun HJ, Yi HJ, Bak KH, Ko Y, Lee YK : Perioperative risk factors related to lumbar spine fusion surgery in korean geriatric patients. J Korean Neurosurg Soc 51 : 350-358, 2012 https://doi.org/10.3340/jkns.2012.51.6.350
  27. Lee JY, Moon SH, Suh BK, Yang MH, Park MS : Outcome and complications in surgical treatment of lumbar stenosis or spondylolisthesis in geriatric patients. Yonsei Med J 56 : 1199-1205, 2015 https://doi.org/10.3349/ymj.2015.56.5.1199
  28. Mahato NK, Sybert D, Law T, Clark B : Effects of spine loading in a patient with post-decompression lumbar disc herniation: observations using an open weight-bearing MRI. Eur Spine J 26 (Suppl 1) : 17-23, 2017 https://doi.org/10.1007/s00586-016-4581-6
  29. Marbacher S, Mannion AF, Burkhardt JK, Schar RT, Porchet F, Kleinstuck F, et al. : Patient-rated outcomes of lumbar fusion in patients with degenerative disease of the lumbar spine. Spine (Phila Pa 1976) 41 : 893-900, 2016 https://doi.org/10.1097/BRS.0000000000001364
  30. Nasser R, Yadla S, Maltenfort MG, Harrop JS, Anderson DG, Vaccaro AR, et al. : Complications in spine surgery. J Neurosurg Spine 13 : 144-157, 2010 https://doi.org/10.3171/2010.3.SPINE09369
  31. Rihn JA, Hilibrand AS, Zhao W, Lurie JD, Vaccaro AR, Albert TJ, et al. : Effectiveness of surgery for lumbar stenosis and degenerative spondylolisthesis in the octogenarian population. J Bone Joint Surg Am 97 : 177-185, 2015 https://doi.org/10.2106/JBJS.N.00313
  32. Rouben D, Casnellie M, Ferguson M : Long-term durability of minimal invasive posterior transforaminal lumbar interbody fusion. J Spinal Disord Tech 24 : 288-296, 2011 https://doi.org/10.1097/BSD.0b013e3181f9a60a
  33. Saleh A, Thirukumaran C, Mesfin A, Molinari RW : Complications and readmission after lumbar spine surgery in elderly patients: an analysis of 2,320 patients. Spine J 17 : 1106-1112, 2017 https://doi.org/10.1016/j.spinee.2017.03.019
  34. Thome C, Zevgaridis D, Leheta O, Bazner H, Pockler-Schoniger C, Wohrle J, et al. : Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J Neurosurg Spine 3 : 129-141, 2005 https://doi.org/10.3171/spi.2005.3.2.0129
  35. Tuite GF, Stem JD, Doran SE, Papadopoulos SM, McGillicuddy JE, Oyedijo DI, et al. : Outcome after laminectomy for lumbar spinal stenosis. Part I: clinical correlations. J Neurosurg 81 : 699-706, 1994 https://doi.org/10.3171/jns.1994.81.5.0699
  36. Vitaz TW, Raque GH, Shields CB, Glassman SD : Surgical treatment of lumbar spinal stenosis in patients older than 75 years of age. J Neurosurg 91(2 Suppl) : 181-185, 1999
  37. Weinstein JN, Lurie JD, Tosteson TD, Zhao W, Blood EA, Tosteson AN, et al. : Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. Four-year results in the spine patient outcomes research trial (SPORT) randomized and observational cohorts. J Bone Joint Surg Am 91 : 1295-1304, 2009 https://doi.org/10.2106/JBJS.H.00913

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  7. Minimally invasive lumbar decompression: a review of indications, techniques, efficacy and safety vol.10, pp.5, 2020, https://doi.org/10.2217/pmt-2020-0037
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