title: Effect of age on the perioperative and radiographic complications of multilevel cervicothoracic spinal fusions.
abstract: METHODS
  Retrospective review.
  
  
  OBJECTIVE
  To investigate the effect of age on the perioperative and radiographic complications associated with multilevel (>or=5) fusion of the cervicothoracic spine.
  
  
  BACKGROUND
  Although the elderly comprise a substantial proportion of patients presenting with complex spinal pathology necessitating multilevel procedures across the cervical and cervicothoracic spine, the risk of perioperative and radiographic complications after these procedures is unknown.
  
  
  METHODS
  Between 2000 and 2007, 58 patients 65 years of age or older at a single institution underwent instrumented cervicothoracic spinal fusion of at least 5 levels. Fifty-eight patients under the age of 65 from the same time period served as a control group. A retrospective review of all hospital records, operative reports, radiographs, and clinic notes was conducted. Complications were classified as intraoperative, major and minor postoperative, and need for revision surgery. Flexion-extension radiographs were examined at discharge, 1.5, 6, 12 months, and then yearly, thereafter to evaluate fusion status and instrumentation-related complications.
  
  
  RESULTS
  Principal diagnoses included spondylostenosis, malignancy, vertebral fracture, and osteomyelitis. Both groups were similar in number of levels fused (elderly, 6.7 +/- 2.1; control, 6.3 +/- 1.7) and circumferential procedures (27 vs. 28), respectively. There were no significant differences in operative time, blood loss, or length of hospital stay. Rates of intraoperative (5.2% vs. 3.4%), major (20.7% vs. 17.2%) and minor postoperative complications (27.6% vs. 22.4%), and reoperation (8.6% vs. 8.6%) were similar between the 2 groups. Utilization of a combined anterior-posterior fusion was associated with increased perioperative complications in the elderly on univariate but not multivariate analyses. Radiographic evidence of fusion was also comparable between the 2 groups.
  
  
  CONCLUSIONS
  Perioperative complication rates of multilevel (>or=5) cervicothoracic spinal fusion in the elderly are high but not significantly different from those of younger patients. The use of a circumferential fusion procedure may increase the risk of a perioperative complication in older patients. Fusion rates are similar between the 2 groups.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA.
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Cloyd
authors.forename: Frank L
authors.initials: FL
authors.lastname: Acosta
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery