Impact of instrumentation in lumbar spinal fusion in elderly patients: 71 patients followed for 2-7 years.
OBJECTIVE
An increasing number of lumbar fusions are performed using allograft to avoid donor-site pain. In elderly patients, fusion potential is reduced and the patient may need supplementary stability to achieve a solid fusion if allograft is used. We investigated the effect of instrumentation in lumbar spinal fusion performed with fresh frozen allograft in elderly patients.


METHODS
94 patients, mean age 70 (60-88) years, who underwent posterolateral spinal fusion either non-instrumented (51 patients) or instrumented (43 patients) were followed for 2-7 years. Functional outcome was assessed with the Dallas pain questionnaire (DPQ), the low back pain rating scale pain index (LBPRS), and SF-36. Fusion was assessed using plain radiographs.


RESULTS
Instrumented patients had statistically significantly better outcome scores in 6 of 7 parameters. Fusion rate was higher in the instrumented group (81% vs. 68%, p = 0.1). Solid fusion was associated with a better functional outcome at follow-up (significant in 2 of 7 parameters). 15 patients (6 in the non-instrumented group and 9 in the instrumented group) had repeated lumbar surgery after their initial fusion procedure. Functional outcome was poorer in the group with additional spine surgeries (significant in 4 of 7 parameters).


CONCLUSIONS
Superior outcomes after lumbar spinal fusion in elderly patients can be achieved by use of instrumentation in selected patients. Outcome was better in patients in which a solid fusion was obtained. Instrumentation was associated with a larger number of additional surgeries, which resulted in a lesser degree of improvement. Instrumentation should not be discarded just because of the age of the patient.
Andersen
Thomas
T
Spine Unit, Department of Orthopaedics E, Aarhus University Hospital, Aarhus, Denmark. tba@dadlnet.dk
Christensen
Finn B
FB
Niedermann
Bent
B
Helmig
Peter
P
Høy
Kristian
K
Hansen
Ebbe S
ES
Bünger
Cody
C
D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D016025:Bone Transplantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D010147:Pain Measurement; D012086:Reoperation; D013123:Spinal Fusion / Q000295:instrumentation*; D011795:Surveys and Questionnaires; D014184:Transplantation, Homologous; D016896:Treatment Outcome