Is Older Age a Contraindication for Single-Level Transforaminal Lumbar Interbody Fusion?

Abstract

This study's primary objective was to compare the clinico-radiological outcomes and incidence of perioperative complications of transforaminal lumbar interbody fusion (TLIF) at lower lumbar levels for elderly and younger patients. The secondary objective was to evaluate the effect of age on clinical outcomes and patient satisfaction in the two groups. Overview of Literature: The lumbar interbody fusion surgery in elder age has been reported to produce a higher complication rate and suboptimal results. Literature evaluating efficacy and safety of TLIF in elderly population is scanty. The effect of age on clinical outcome and the overall patient satisfaction after TLIF has been understudied. Methods: This retrospective study was conducted from 2011 to 2017 with 121 patients, who underwent TLIF and were divided into two cohorts based on age (group A, >65 years and group B, <65 years). Perioperative clinical/radiological parameters, postoperative complications, and satisfactory outcomes were evaluated in both groups. A statistical analysis between two matched groups was performed with logistic regression analysis and Student t-test. Results: The mean age was 73.8±4.5 years in group A and 47.3±12.7 years in group B. There was no statistical difference in surgical time (p=0.15), mobilization, or hospital stay (p=0.15) between the two groups. There were no statistically significant differences noted in the Oswestry Disability Index, Visual Analog Scale, or Wang's outcome score between the two groups at final follow-up. Postoperative complications not affecting outcome were common in the elderly group, but there was no statistically significant difference noted among neurological or cardiopulmonary events between the two groups. Conclusions: In judiciously selected patients with proper preoperative risk assessment and optimized medical co-morbidities, TLIF surgery can have successful results, in terms of clinical outcome and satisfaction, in the elderly. Older age should not be a contraindication for TLIF in patients with degenerative lumbar disease.

Improvement following minimally invasive transforaminal lumbar interbody fusion in patients aged 70 years or older compared with younger age groups

“…17 Two similar studies also demonstrated good clinical outcomes following MI-TLIF irrespective of age. 13,14 These findings of comparable outcomes across age groups emphasize the advantage of the use of minimally invasive techniques for lumbar fusion in the elderly. Previously, Glassman et al had demonstrated that following open TLIF, older patients may have worse outcomes compared to younger patients.…”

“…Transforaminal lumbar interbody fusion (TLIF) is regarded as a workhorse technique for the treatment of degenerative conditions of the lumbar spine. 13 Although various studies have been previously conducted to assess the outcomes of minimally invasive TLIF (MI-TLIF) in the elderly, [13][14][15][16][17][18] only a few have reported minimum clinically important difference (MCID) achievement rates, 17,18 and none have reported the time taken to achieve MCID, return to activities, and discontinue opioids postoperatively. Therefore, the purpose of this comparative study was to fill this gap in the literature by assessing the MCID achievement, return to activities, and opioid discontinuation, in addition to analyzing the improvement in patientreported outcome measures (PROMs), fusion rates, and complication/reoperation rates in patients ≥ 70 years old following MI-TLIF.…”

Lumbar Spinal Stenosis: Review Update 2022

“…The sagittal plane must be adjusted for fusion surgery to be successful, and even elderly patients aged over 65 and very senior patients aged over 80 can have successful operations provided the sagittal plane is balanced thereafter. Gained is decrease the chance of falls following surgery [28,29,53,54]. Recently, single-or biport endoscopic surgery and minimally invasive screw [59].…”

Letter to the Editor: Is Older Age a Contraindication for Single-Level Transforaminal Lumbar Interbody Fusion?

“…We have read the article “ Is older age a contraindication for single-level transforaminal lumbar interbody fusion?” by Patel et al [ 1 ] with great interest and appreciate the authors for their informative work. This article was extensively discussed in our departmental journal club meeting recently and few doubts were raised which seek solution and redressal before establishing safety and utility of transforaminal lumbar interbody fusion (TLIF) amongst the elderly.…”