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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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Outcome score at long-term follow-up according to whether the patient had additional spine surgery after the initial fusion procedure.
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Figure 0003: Outcome score at long-term follow-up according to whether the patient had additional spine surgery after the initial fusion procedure.

Mentions: 15 patients (6/51 in the non-instrumented group and 9/43 in the instrumented group) had a self-reported or chart history of repeated surgery to their lumbar spine after their initial fusion procedure: additional decompression at either adjacent or included levels, or re-fusions. 4 of the instrumented patients had the hardware removed due to loosening. Average age at operation in the reoperated group was 69 (60–79) years, which was no different from the group without reoperations. Functional outcome in the reoperated group was poorer than in single-surgery group (Figure 3). 8 of the reoperated patients reported use of pain medication on a daily basis, as compared to 30 in the group that did not have repeat surgery (p = 0.4). Furthermore, the median DDD was 1.4 (0.1–2.0) in the reoperated group as compared to 0.3 (0.1–1.0) in the single-surgery group (p = 0.3).


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)

Outcome score at long-term follow-up according to whether the patient had additional spine surgery after the initial fusion procedure.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0003: Outcome score at long-term follow-up according to whether the patient had additional spine surgery after the initial fusion procedure.
Mentions: 15 patients (6/51 in the non-instrumented group and 9/43 in the instrumented group) had a self-reported or chart history of repeated surgery to their lumbar spine after their initial fusion procedure: additional decompression at either adjacent or included levels, or re-fusions. 4 of the instrumented patients had the hardware removed due to loosening. Average age at operation in the reoperated group was 69 (60–79) years, which was no different from the group without reoperations. Functional outcome in the reoperated group was poorer than in single-surgery group (Figure 3). 8 of the reoperated patients reported use of pain medication on a daily basis, as compared to 30 in the group that did not have repeat surgery (p = 0.4). Furthermore, the median DDD was 1.4 (0.1–2.0) in the reoperated group as compared to 0.3 (0.1–1.0) in the single-surgery group (p = 0.3).

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