Lumbar decompression and fusion in elderly osteoporotic patients: a prospective study using less rigid titanium rod fixation.
METHODS
A 2 to 4-year clinical and radiologic prospective study was conducted for 39 patients over the age of 65 treated by lumbar arthrodesis.


OBJECTIVE
Evaluate the quality of lumbar arthrodesis results in elderly patients, in which the bone osteoporosis (poor quality of the spine's anatomic components) and general factors (frequent comorbidity) are likely to make this surgery difficult if not dangerous and evaluate a dedicated instrumentation for osteoporotic bone.


METHODS
Thirty-nine patients over 65 years of age (average 73 y) underwent arthrodesis surgery in 2001 and 2002 and were followed for at least 2 years. The instrumentation used (Equation, Medtronic, Memphis, USA) was selected for its mechanical properties adapted for bone of poor mechanical quality. The clinical analysis was based on Oswestry, Visual Analog Scale, and Japanese Orthopaedic Association scores. Radiologic results were evaluated on standard anteroposterior, lateral, and 3/4 radiographs, and computed tomography scans if necessary.


RESULTS
All the patients were followed for 2 to 4 years. Clinical analysis confirmed a very satisfactory progression of the clinical parameters such as lumbar and radicular pain, and the results were maintained between the first and second years and at last follow-up. No serious general complication or need for reoperation was seen in this series. On x-rays, 35 grafts appear to have fused. The anchors did not come out nor did the instrumentation come apart. On the other hand, 2-year radiographs revealed that 2 screws and 2 rods had failed, but this did not affect correction in the 4 completely asymptomatic patients. These 4 cases are considered stable at last follow-up.


CONCLUSIONS
Arthrodesis for elderly patients will undoubtedly increase in the coming years. The conditions for this surgery are different than those for younger patients and it is desirable to try to provide reliable surgical techniques and solutions regarding options for instrumentation and overall perioperative care for these fragile patients. Dedicated instrumentation for osteoporotic bone seems to allow good clinical outcomes.
Cavagna
Remi
R
Clinique du Ter, Ploemeur, Nantes, France.
Tournier
Clement
C
Aunoble
Stephane
S
Bouler
Jean M
JM
Antonietti
Pierre
P
Ronai
Martin
M
Le Huec
Jean-Charles
JC
D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D019299:Decompression, Surgical / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D011859:Radiography; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D014025:Titanium; D016896:Treatment Outcome
D014025:Titanium