title: 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.
abstract: 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.
authors.affiliation: Department of Orthopaedics, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taipei.
authors.forename: Chin-Hsien
authors.initials: CH
authors.lastname: Wu
authors.forename: Yu-Hsien
authors.initials: YH
authors.lastname: Kao
authors.forename: Shih-Chieh
authors.initials: SC
authors.lastname: Yang
authors.forename: Tsai-Sheng
authors.initials: TS
authors.lastname: Fu
authors.forename: Po-Liang
authors.initials: PL
authors.lastname: Lai
authors.forename: Wen-Jer
authors.initials: WJ
authors.lastname: Chen
mesh_terms: 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