Life Quality After Instrumented Lumbar Fusion in the Elderly

Becker, Philipp; Bretschneider, Wolfgang; Tuschel, A; Ogon, M

doi:10.1097/brs.0b013e3181c62294

Cited by 33 publications

(23 citation statements)

References 17 publications

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“…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.…”

Section: Discussionsupporting

confidence: 87%

“…The radiological exams showed initial signs of fusion in 52 cases: in one case bony reabsorption around screws of L5 were detected and the patient underwent revision surgery of the instrumentation. The last follow-up performed at 18.4 months (range [15][16][17][18][19][20] was completed for 49 patients of the initial 53: one had died and the other three were lost at the follow-up time. The mean final clinical evaluation tools were: VAS = 1.8 and ODI = 21.8 %, with a statistically significant improvement (p = 0.004).…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2013

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Section: Discussionsupporting

confidence: 87%

Section: Resultsmentioning

confidence: 99%

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

et al. 2013

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“…This supports previously published data by Becker et al, 1 who demonstrated an improvement in QOL measures in elderly patients following instrumented lumbar fusion. These data bolster the case for not considering age to be an inherent contraindication to instrumented fusion.…”

supporting

confidence: 82%

Cost-effectiveness of confirmatory techniques for the placement of lumbar pedicle screws

Sanborn

Thawani

Whitmore

et al. 2012

FOC

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Object There is considerable variation in the use of adjunctive technologies to confirm pedicle screw placement. Although there is literature to support the use of both neurophysiological monitoring and isocentric fluoroscopy to confirm pedicle screw positioning, there are no studies examining the cost-effectiveness of these technologies. This study compares the cost-effectiveness and efficacy of isocentric O-arm fluoroscopy, neurophysiological monitoring, and postoperative CT scanning after multilevel instrumented fusion for degenerative lumbar disease. Methods Retrospective data were collected from 4 spine surgeons who used 3 different strategies for monitoring of pedicle screw placement in multilevel lumbar degenerative disease. A decision analysis model was developed to analyze costs and outcomes of the 3 different monitoring strategies. A total of 448 surgeries performed between 2005 and 2010 were included, with 4 cases requiring repeat operation for malpositioned screws. A sample of 64 of these patients was chosen for structured interviews in which the EuroQol-5D questionnaire was used. Expected costs and quality-adjusted life years were calculated based on the incidence of repeat operation and its negative effect on quality of life and costs. Results The decision analysis model demonstrated that the O-arm monitoring strategy is significantly (p < 0.001) less costly than the strategy of postoperative CT scanning following intraoperative uniplanar fluoroscopy, which in turn is significantly (p < 0.001) less costly than neurophysiological monitoring. The differences in effectiveness of the different monitoring strategies are not significant (p = 0.92). Conclusions Use of the O-arm for confirming pedicle screw placement is the least costly and therefore most cost-effective strategy of the 3 techniques analyzed.

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“…They were able to demonstrate that e elderly patients benefit from spinal fusion but they do not distinguish between the two methods [13]. …”

Section: Discussionmentioning

confidence: 99%

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

Endres¹,

Aigner²,

Wilke³

2011

BMC Musculoskelet Disord

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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.

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Life Quality After Instrumented Lumbar Fusion in the Elderly

Abstract: Age itself cannot be considered a contraindication.

Cited by 33 publications

References 17 publications

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

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

Cost-effectiveness of confirmatory techniques for the placement of lumbar pedicle screws

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

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