title: Instrumentation-related complications of multilevel fusions for adult spinal deformity patients over age 65: surgical considerations and treatment options in patients with poor bone quality.
abstract: METHODS
  Retrospective follow-up of patients over the age of 65 with a minimum of five-level fusions.
  
  
  OBJECTIVE
  To determine the effect on outcomes of long constructs in patients with poor bone stock, and to review surgical techniques used in patients with poor bone stock.
  
  
  BACKGROUND
  Scoliotic deformities in patients with poor bone stock require alterations in both the surgical technique and preoperative planning. To our knowledge, complications of long constructs in poor bone stock have not been specifically reported.
  
  
  METHODS
  Patients over the age of 65 that underwent a minimum of five-level fusion over a 5-year period were reviewed. We reviewed both operative reports and clinic notes and recorded both early and late complications.
  
  
  RESULTS
  Early complications included pedicle fractures and compression fractures with an overall rate of 13%. Late complications included pseudarthroses with instrumentation failure, adjacent level disc degeneration with herniation, compression fractures, and progressive kyphosis. Progressive junctional kyphosis occurred in 26% of patients.
  
  
  CONCLUSIONS
  Spinal stabilization surgery in patients with poor bone stock is associated with high complication rates. Complications such as progressive kyphosis adjacent to the fusion are difficult to address with instrumentation alone.
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA. orthoscoli@aol.com
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: DeWald
authors.forename: Thomas
authors.initials: T
authors.lastname: Stanley
mesh_terms: D000367:Age Factors; D000368:Aged; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects*; D007405:Intervertebral Disc Displacement / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D007738:Kyphosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D010024:Osteoporosis / Q000150:complications* / Q000503:physiopathology; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D011300:Preoperative Care / Q000592:standards; D012189:Retrospective Studies; D013121:Spinal Curvatures / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D013131:Spine / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D017211:Treatment Failure