title: Minimally invasive lumbar interbody fusion in patients older than 70 years of age: analysis of peri- and postoperative complications.
abstract: BACKGROUND
  The number of spine operations performed in the elderly population is rising.
  
  
  OBJECTIVE
  To identify and describe perioperative and postoperative complications in patients 70 years and older who have undergone minimally invasive lumbar interbody spine fusion.
  
  
  METHODS
  A retrospective analysis was performed on 66 consecutive patients aged 70 years or older who underwent a minimally invasive interbody lumbar fusion. Electronic medical records were analyzed for patient demographics, procedures, and perioperative and postoperative complications.
  
  
  RESULTS
  Between 2000 and 2009, 66 patients with an average age of 74.9 years (range, 70-86 years) underwent 68 lumbar interbody fusions procedures. The mean follow-up was 14.7 months (range, 1.5-50 months). The minimally invasive approaches included 41 cases of extreme lateral interbody fusion and 27 minimally invasive transforaminal lumbar interbody fusions. We observed 5 major (7.4%) and 17 minor (25%) complications. The 5 major complications consisted of 4 cases of interbody graft subsidence and 1 adjacent level disease. There were no intraoperative medical complications. There were no myocardial infarctions, pulmonary embolisms, hardware complications requiring removal, wound infections, major visceral, vascular, neural injuries, or death in the study period.
  
  
  CONCLUSIONS
  Minimally invasive interbody fusions can be performed in the elderly (ages 70 years and older) with an overall low rate of major complications. Graft subsidence in this population when not supplemented with posterior instrumentation is a concern. Age should not be a deterrent to performing complex minimally invasive interbody fusions in the elderly.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Isaac O
authors.initials: IO
authors.lastname: Karikari
authors.forename: Peter M
authors.initials: PM
authors.lastname: Grossi
authors.forename: Shahid M
authors.initials: SM
authors.lastname: Nimjee
authors.forename: Carolyn
authors.initials: C
authors.lastname: Hardin
authors.forename: Tiffany R
authors.initials: TR
authors.lastname: Hodges
authors.forename: Betsy D
authors.initials: BD
authors.lastname: Hughes
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Brown
authors.forename: Robert E
authors.initials: RE
authors.lastname: Isaacs
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome