Impact of instrumentation in lumbar spinal fusion in elderly patients
نویسندگان
چکیده
BACKGROUND AND PURPOSE An increasing number of lumbar fusions are performed using allograft to avoid donor-site pain. In elderly patients, fusion potential is reduced and the patient may need supplementary stability to achieve a solid fusion if allograft is used. We investigated the effect of instrumentation in lumbar spinal fusion performed with fresh frozen allograft in elderly patients. METHODS 94 patients, mean age 70 (60-88) years, who underwent posterolateral spinal fusion either non-instrumented (51 patients) or instrumented (43 patients) were followed for 2-7 years. Functional outcome was assessed with the Dallas pain questionnaire (DPQ), the low back pain rating scale pain index (LBPRS), and SF-36. Fusion was assessed using plain radiographs. RESULTS Instrumented patients had statistically significantly better outcome scores in 6 of 7 parameters. Fusion rate was higher in the instrumented group (81% vs. 68%, p = 0.1). Solid fusion was associated with a better functional outcome at follow-up (significant in 2 of 7 parameters). 15 patients (6 in the non-instrumented group and 9 in the instrumented group) had repeated lumbar surgery after their initial fusion procedure. Functional outcome was poorer in the group with additional spine surgeries (significant in 4 of 7 parameters). INTERPRETATION Superior outcomes after lumbar spinal fusion in elderly patients can be achieved by use of instrumentation in selected patients. Outcome was better in patients in which a solid fusion was obtained. Instrumentation was associated with a larger number of additional surgeries, which resulted in a lesser degree of improvement. Instrumentation should not be discarded just because of the age of the patient.
منابع مشابه
Frequency of Instrumentation in Lumbar Spinal Stenosis and Lumbar Disc Herniation
Background & Aim: Lumbosacral pain is extremely common as age increases. Spinal instrumentation is sometimes recommended for lumbar canal stenosis and disk herniation surgery. This study aimed at studying the frequency of instrumentation in patients referring to our center. Methods & Materials/Patients: This retrospective cross-sectional study included 1200 patients with low back and...
متن کاملThe Effects of Posterior Spinal Fusion in Patients with Limitations of Anterior Approach: The Experience of Six Cases
Background & Importance: Spinal deformity is one of the most common disorders among the vertebral diseases that results from unnatural curvatures of spine, such as scoliosis and kyphosis. Spinal fusion surgery is used most commonly to treat certain types of spinal deformity. Herein, we reported the efficacy of posterior spinal fusion accompanied by instrumentation in patients with the...
متن کاملArguments for the choice of surgical treatments in patients with lumbar spinal stenosis – a systematic appraisal of randomized controlled trials
BACKGROUND Lumbar spinal stenosis is the most common reason for spinal surgery in elderly patients. However, the surgical management of spinal stenosis is controversial. The aim of this review was to list aspects a surgeon considers when choosing a specific type of treatment. METHODS Appraisal of arguments reported in randomized controlled trials (RCTs) included in systematic reviews publishe...
متن کاملLong-term result of posterolateral fusion of the lumbar spine using the Tadpole system
BACKGROUND Failure of pedicle screw fixation is often seen in patients with severe osteoporosis. We developed new lumbar spinal instrumentation (Tadpole system) for elderly patients who have osteoporotic bone and poor general health status. The objective of this study was to document the long-term clinical outcomes after Tadpole system fixation, the rate of spinal fusion, the incidence of adjac...
متن کاملProximal junctional kyphosis in adolescent idiopathic scoliosis following segmental posterior spinal instrumentation and fusion minimum 2 years follow-up
Abstract Background: To evaluate proximal junctional segment changes in Adolescent Idiopathic Scoliosis(AIS) the posterior spinal fusion and also instrumentation also and finding of probable risk factors, were all considered in this study. Methods: We retrospectively reviewed radiographs of 121 consecutive patients who underwent posterior spinal fusion for AIS from T3 or below, with...
متن کامل