Impact of instrumentation in lumbar spinal fusion in elderly patients

Autor:	Ebbe Stender Hansen, Cody Bünger, Bent Niedermann, Kristian Høy, Finn B. Christensen, Peter Helmig, Thomas Andersen
Rok vydání:	2009
Předmět:	medicine.medical_specialty Schmidt sting pain index business.industry medicine.medical_treatment Arthrodesis General Medicine Lumbar vertebrae Low back pain Surgery Vertebra Lumbar medicine.anatomical_structure Spinal fusion Anesthesia Orthopedic surgery medicine Orthopedics and Sports Medicine medicine.symptom business
Zdroj:	Acta Orthopaedica. 80:445-450
ISSN:	1745-3682 1745-3674
DOI:	10.3109/17453670903170505
Popis:	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.
Databáze:	OpenAIRE
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