The Efficacy and Perioperative Complications Associated with Lumbar Spinal Fusion Surgery, Focusing on Geriatric Patients in the Republic of Korea

Abstract

ObjectiveThe purpose of this study was to examine the efficacy and perioperative complications associated with lumbar spinal fusion surgery, focusing on geriatric patients in the Republic of Korea.MethodsWe retrospectively investigated 485 patients with degenerative spinal diseases who had lumbar spinal fusion surgeries between March 2006 and December 2010 at our institution. Age, sex, comorbidity, American Society of Anesthesiologists (ASA) class, fusion segments, perioperative complications, and outcomes were analyzed in this study. Risk factors for complications and their association with age were analyzed.ResultsIn this study, 81 patients presented complications (16.7%). The rate of perioperative complications was significantly higher in patients 70 years or older than in other age groups (univariate analysis, p=0.015; multivariate analysis, p=0.024). The perioperative complications were not significantly associated with the other factors tested (sex, comorbidity, ASA class, and fusion segments). Post-operative outcomes of lumbar spinal fusion surgeries for the patients were determined on the basis of MacNab's criteria (average follow up period : 19.7 months), and 412 patients (85.0%) were classified as having "excellent" or "good" results.ConclusionIncreasing age was an important risk factor for perioperative complications in patients undergoing lumbar spinal fusion surgery, whereas other factors were not significant. However, patients' satisfaction or return to daily activities when compared with younger patients did not show much difference. We recommend good clinical judgment as well as careful selection of geriatric patients for lumbar spinal fusion surgery.

Patient-Rated Outcomes of Lumbar Fusion in Patients With Degenerative Disease of the Lumbar Spine

“…4,5,23,24 Studies on patient-rated outcome in older and geriatric patients are rare, often lack a comparison with a control group, and involve only a small number of patients; however, in good agreement with our findings, the majority report that older patients (>70 years of age) benefit as much from lumbar spinal fusion as do younger patients. 7,[24][25][26] Okuda et al 7 compared 31 patients older than 70 years of age with 70 patients younger than 70 years of age and found that elderly patients demonstrated satisfactory clinical and radiographic results, similar to those in younger patients. Acosta et al 26 found perioperative events, intermediate-term clinical outcomes (mean follow-up of 19 months), and fusion rates after multilevel 3608 lumbar fusion in the elderly (>65 years, n ¼ 30) comparable with those of younger patients (<65 years, n ¼ 43).…”

Reengineering autologous bone grafts with the stem cell activator WNT3A

“…Three-dimensional reconstructions of the micro-CT data demonstrated poor bone regeneration in sites treated with BGM aged (grey; Fig. 6H), in agreement with similar data from elderly patients undergoing spine fusion [65,66]. In contrast, sites treated with BGM WNT showed evidence of robust bone formation and fusion of the transverse processes (blue; Fig.…”

Patient-rated Outcomes of Lumbar Fusion in Patients with Degenerative Disease of the Lumbar Spine: Does Age Matter?

“…Most previous studies on posterior lumbar interbody fusion in elderly patients have focused on complication rates and, to a lesser extent, on clinical results 4,5,23,24 . Reports on patient-rated outcome in older and geriatric patients are rare, often lack a comparison with a control group, and involve only a small number of patients.…”