title: Instrumented intervertebral or posterolateral fusion in elderly patients: clinical results of a single center.
abstract: BACKGROUND
  Data on the clinical outcome after spinal fusion in the elderly patient are rare. To our knowledge there has been no clinical outcome assessment for instrumented spinal fusion in elderly patients comparing posterolateral fusion with intervertebral fusion. Aim of the current study was to evaluate the clinical outcome of elderly patients who underwent a spinal fusion procedure for degenerative spinal stenosis with instability. Main hypothesis was to test whether it is necessary to force an intervertebral fusion for a better clinical outcome in spinal fusion surgery of the elderly or not.
  
  
  METHODS
  Two subgroups - posterolateral fusion versus intervertebral fusion (cage vs. non-cage) were compared with regard to functional outcome, fusion rates and complications after a mean follow up of 3.8 years. Questionnaires were completed by the patients before surgery and at final follow-up. Changes in mean VAS and ODI scores (decrease from the baseline VAS and ODI scores) were compared.
  
  
  RESULTS
  The mean final follow up for all subjects was 3.8 years. Of the 114 patients, 2 patients were deceased at the time of the follow-up, 5 patients didn't want to participate and 107 patients completed the questionnaires. This resulted in an overall follow-up rate of 93%. At final follow-up, the patients demonstrated significant improvement in the VAS and ODI- compared with the preoperative scores in both groups. But overall there were no significant differences between both groups regarding the outcome assessment using the ODI and VAS.
  
  
  CONCLUSIONS
  The results of this study shows that elderly patients aged over 75 benefit from instrumented lumbar fusion. The study suggests that there is no need to force an intervertebral fusion because elderly patients do not seem to benefit from this procedure.
authors.affiliation: Department of orthopaedic surgery, Elisabeth-Klinik Bigge/Olsberg, Heinrich Sommer Strasse 4, 59939 Olsberg, Germany. s.endres@elisabeth-klinik.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Endres
authors.forename: Rene
authors.initials: R
authors.lastname: Aigner
authors.forename: Axel
authors.initials: A
authors.lastname: Wilke
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators / Q000592:standards; D007403:Intervertebral Disc / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods*; D013130:Spinal Stenosis / Q000601:surgery*; D055009:Spondylosis / Q000601:surgery*; D016896:Treatment Outcome