Supplementary pedicle screw fixation in spinal fusion for degenerative spondylolisthesis in patients aged 65 and over: outcome after a minimum of 2 years follow-up in 82 patients.
BACKGROUND
There have been few reports assessing the outcome of laminectomy and posterolateral fusion with pedicle screw fixation for degenerative spondylolisthesis in the elderly. In a retrospective study, we assessed the clinical and radiographic outcome of this treatment in degenerative spondylolisthesis patients aged >or= 65 years.


METHODS
82 patients (61 females) aged >or= 65 years underwent laminectomy and posterolateral fusion with pedicle screw fixation for degenerative spondylolisthesis. The median age at surgery was 69 (65-79) years. The mean bone mineral density before surgery was -1.9 (-1.0 to -2.5). After an average of 3 (2-11) years follow-up, patients were classified as "satisfied" or "dissatisfied" according to self-reported outcomes and also as "solid fusion" or "no solid fusion" according to the radiographic findings.


RESULTS
At final follow-up, the average Oswestry disability index (ODI) score was lower than the preoperative score (30 vs. 56) (p = 0.03). Four-fifths of the patients stated that they were satisfied with the outcome. Almost three-quarters of the patients achieved definite fusion. Although patients with advanced age or reduced bone mineral density were not more likely to have dissatisfactory results (p = 0.8 and p = 0.6, respectively) they were more likely to have radiographic results showing "absence of solid fusion" (p = 0.005 and p < 0.001, respectively).


CONCLUSIONS
We believe that supplementary pedicle screw fixation after laminectomy and posterolateral fusion will be an effective choice for the ever-increasing number of patients aged >or= 65 years who will be prone to develop degenerative spondylolisthesis.
Wu
Chin-Hsien
CH
Department of Orthopaedics, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taipei.
Kao
Yu-Hsien
YH
Yang
Shih-Chieh
SC
Fu
Tsai-Sheng
TS
Lai
Po-Liang
PL
Chen
Wen-Jer
WJ
D000368:Aged; D015519:Bone Density; D001863:Bone Screws; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D007796:Laminectomy / Q000295:instrumentation / Q000379:methods; D008297:Male; D017060:Patient Satisfaction; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome