Surgical Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion in Elderly

Abstract

The purpose of this study was to compare the clinical-radiological outcome and incidence of perioperative complications of MIS-TLIF at lower lumbar levels for elderly (Age >65 years) and younger patients (Age<65 years). Methods: A retrospective cohort study performed from 2011 to 2017. A total 138 patients who underwent MIS-TLIF were divided into two groups based on age (group A>65 years and group B<65 years). Perioperative clinical (co-morbidities, surgical time, blood loss, hospital stay, fusion level, VAS, ODI), radiological parameters (fusion, cage subsidence, implant failure), postoperative complications and satisfactory outcomes in the form of Wang's criteria were evaluated in both the groups. A statistical analysis between two matched groups was done with logistic regression analysis, chisquare and student t-test. Results: There was no statistical difference in blood loss, surgical time, mobilization and hospital stay between two groups however elderly patients took longer time to become pain free (p=0.001). Both groups showed significant improvement in ODI, VAS and Wang's outcome score however, no statistically significant difference noted in outcome between two groups at final follow up. General complications not affecting outcome were common in elderly group but no statistically significant difference noted among neurological events between both groups. Conclusion: MISS-TLIF surgery in elderly can produce successful clinical outcome and satisfaction after surgery in judiciously selected patients with proper preoperative risk assessment and optimization of medical co-morbidities. Elder age does not prove deterrent to outcome and should not be a contraindication to perform MISS-TLIF in lumbar degenerative diseases.

Outcomes and complications of minimally invasive transforaminal lumbar interbody fusion in the elderly: a systematic review and meta-analysis

“…1). [20][21][22][23][24][25][26][27][28][29][30][31] Two studies performed prospective data collection and analysis, 21,29 whereas the remaining 10 performed retrospective analyses.…”

“…27 Studies defined elderly patients variably. The most common cutoff age was 65 years (7 studies, 58%), [22][23][24][25][26]28,30 followed by 70 years (3 studies, 25%). 20,21,31 One study used an 80-year cutoff, 27 and the remaining study divided the patient cohort into age groups of equal size, which resulted in a cutoff age of 66 years.…”

“…20,21,[24][25][26][28][29][30][31] Four of 6 studies (67%) 20,25,28,30 reported increased comorbidity in elderly versus nonelderly patients, and 4 of 8 studies (50%) 20,24,26,30 found a significantly longer length of stay in elderly patients. One of 6 studies (17%) 28 reported an increase in estimated blood loss, and 1 of 9 studies (11%) 28 reported an increased complication rate between elderly and nonelderly patients, with the remaining studies noting no significant difference. Operation time and fusion rates did not differ between elderly and nonelderly patients in any study.…”

“…2). [24][25][26]28,30 Elderly patients had significantly higher rates of major, minor, and overall complications, with respective ORs of 2.15 (95% CI 1.07-4.34), 2.20 (95% CI 1.22-3.95), and 2.21 (95% CI 1.12-4.37) in elderly compared to nonelderly patients. Study heterogeneity was low for all types of complications (I 2 = 0).…”

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

“…The surgical outcomes of MIS-TLIF is highly impacted by aging; however, a recent retrospective study in the elderly (>65 years) and younger (<65 years) patients revealed significant improvements in both groups with no significant difference in blood loss, hospitalization stay time period, mobilization, and ODI, VAS, and Wang’s score. This indicate that the aging is not a deterrent to outcome and should not be considered as a contraindication to perform MIS-TLIF in the older population [ 88 ]. In another retrospective study, the efficacy of grade 1 fusion and complication rates were identical in middle- and old-aged patients at the end of 2-year follow-up [ 89 ].…”