Outcomes and Complications of Minimally Invasive Surgery of the Lumbar Spine in the Elderly

Abstract

Introduction: Minimally invasive spine (MIS) surgery is gaining popularity in the elderly. With aging population and a strong desire for all patients to remain physically active, this trend will likely continue. Previous studies have reported clinical outcomes in the elderly undergoing MIS surgery; however, most of these studies encompass multiple surgeons at different sites and thus present heterogeneous experiences. In this work, we investigate the clinical outcomes and complications of all lumbar MIS procedures performed in patients over 65 years of age by a single surgeon.

Methods: A retrospective analysis of a prospectively maintained database of spine surgeries was performed. Twenty-six patients who underwent 27 procedures were included.

Results: Mean age at surgery was 72 years (range 64-86). The mean BMI was 30.2 kg/m(2), patients had an average of 5 comorbidities, took 9 medications, and 15% were smokers. The mean symptoms duration was 40.6 months with the numeric rating scale (NRS) and the Oswestry disability index (ODI) prior to surgery of 7.68 and 50% respectively. Six different types of procedures were performed, the most common was the interlaminar decompression and fusion (ILIF) followed by MIS laminectomy, microdiscectomy and MIS lateral fusion (XLIF). 74% of the surgeries were done at a single level. Average blood loss was 43 mL, and the mean length of stay was 1.7 days. There were three complications (11.1%): one urinary tract infection, one pulmonary embolism, and one new, postoperative weakness. At six months follow-up, there was a mean improvement of 27% in ODI, and a 5.6 improvement in NRS (both p<0.05); 90% of patients stated they would have the surgery again.

Conclusion: Minimally invasive lumbar spine surgery is both safe and highly effective in the elderly population. Patient selection is of utmost importance. This data will add to the existing literature on the overall safety and effectiveness of these procedures in the elderly population.

Keywords: adult; aged; minimally invasive surgery; patient outcome assessment; spine.

Figure 1. Type of MIS procedures performed

ILIF: Interlaminar Lumbar Interbody Fusion TLIF: Transforaminal Interbody Fusion XLIF: Extreme Lateral Interbody Fusion MI: Minimally Invasive