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Comparative Study
. 2009 Aug;80(4):445-50.
doi: 10.3109/17453670903170505.

Impact of instrumentation in lumbar spinal fusion in elderly patients: 71 patients followed for 2-7 years

Thomas Andersen  1 , Finn B Christensen, Bent Niedermann, Peter Helmig, Kristian Høy, Ebbe S Hansen, Cody Bünger
Affiliations
Comparative Study

Impact of instrumentation in lumbar spinal fusion in elderly patients: 71 patients followed for 2-7 years

Thomas Andersen et al. Acta Orthop. 2009 Aug.

Abstract

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.

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Figures

Figure 1.
Figure 1.
Dallas pain questionnaire (DPQ) scores according to follow-up time point in the 2 study groups.
Figure 2.
Figure 2.
Long-term follow-up scores for all outcome parameters according to study group. PCS: Physical component summary scale; MCS: Mental component summary scale.
Figure 3.
Figure 3.
Outcome score at long-term follow-up according to whether the patient had additional spine surgery after the initial fusion procedure.
See this image and copyright information in PMC

References

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