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

Andersen T, Christensen FB, Niedermann B, Helmig P, Høy K, Hansen ES, Bünger C - Acta Orthop (2009)

Bottom Line: Instrumented patients had statistically significantly better outcome scores in 6 of 7 parameters.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.Instrumentation was associated with a larger number of additional surgeries, which resulted in a lesser degree of improvement.

View Article: PubMed Central - PubMed

Affiliation: Spine Unit, Department of Orthopaedics E, Aarhus University Hospital, Aarhus, Denmark. tba@dadlnet.dk

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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Long-term follow-up scores for all outcome parameters according to study group. PCS: Physical component summary scale; MCS: Mental component summary scale.
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Figure 0002: Long-term follow-up scores for all outcome parameters according to study group. PCS: Physical component summary scale; MCS: Mental component summary scale.

Mentions: Both the non-instrumented and instrumented group improved from preoperatively to 1-year follow-up, with a much smaller improvement after that. With respect to the two activity-based DPQ scores, improvement was greatest in the instrumented group (Figure 1). Outcome was better in the instrumented group in all outcome parameters and reached statistical significance in 6 of 7 parameters (Figure 2). The SF-36 subscale outcome was still better in the instrumented group, although it was only statistically significant in the Bodily Pain (BP) category: 56 (48–65) vs. 41 (33–50) (p = 0.01). Controlling for differences in age and sex between the groups by using norm-adjusted scores of the SF-36, results were similar. Using the norm-adjusted score, there was a statistically significant difference in favor of the instrumented group in the BP subscale, 75 (64-87) vs. 56 (45-67) (p = 0.01), and in the physical component summary (PCS) scale, 85 (76-93) vs. 72 (64-81) (p = 0.02).


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

Andersen T, Christensen FB, Niedermann B, Helmig P, Høy K, Hansen ES, Bünger C - Acta Orthop (2009)

Long-term follow-up scores for all outcome parameters according to study group. PCS: Physical component summary scale; MCS: Mental component summary scale.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2823186&req=5

Figure 0002: Long-term follow-up scores for all outcome parameters according to study group. PCS: Physical component summary scale; MCS: Mental component summary scale.
Mentions: Both the non-instrumented and instrumented group improved from preoperatively to 1-year follow-up, with a much smaller improvement after that. With respect to the two activity-based DPQ scores, improvement was greatest in the instrumented group (Figure 1). Outcome was better in the instrumented group in all outcome parameters and reached statistical significance in 6 of 7 parameters (Figure 2). The SF-36 subscale outcome was still better in the instrumented group, although it was only statistically significant in the Bodily Pain (BP) category: 56 (48–65) vs. 41 (33–50) (p = 0.01). Controlling for differences in age and sex between the groups by using norm-adjusted scores of the SF-36, results were similar. Using the norm-adjusted score, there was a statistically significant difference in favor of the instrumented group in the BP subscale, 75 (64-87) vs. 56 (45-67) (p = 0.01), and in the physical component summary (PCS) scale, 85 (76-93) vs. 72 (64-81) (p = 0.02).

Bottom Line: Instrumented patients had statistically significantly better outcome scores in 6 of 7 parameters.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.Instrumentation was associated with a larger number of additional surgeries, which resulted in a lesser degree of improvement.

View Article: PubMed Central - PubMed

Affiliation: Spine Unit, Department of Orthopaedics E, Aarhus University Hospital, Aarhus, Denmark. tba@dadlnet.dk

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.

Show MeSH
Related in: MedlinePlus