Journal List > J Korean Soc Spine Surg > v.15(3) > 1035811

Song, Lim, Song, and Ham: Perioperative Complications in Elderly Patients Undergoing Lumbar Arthrodesis with Pedicle Screw Instrumentation in the Degenerative Lumbar Disorders - A Comparative Study between Posterolateral Fusion and Posterior Lumbar Interbody Fusion -

Abstract

Study Design

This is a retrospective study that focused on the perioperative complications when performing posterior arthrodesis for treating degenerative lumbar disorders in elderly patients.

Objectives

We wanted to analyze the perioperative risk factors and the complications associated with posterior lumbar decompression and arthrodesis in patients who were sixty-five years of age or older.

Summary of the Literature Review

Lumbar arthrodesis is commonly done in elderly patients to treat degenerative spine problems. These patients may be at an increased risk for complications because of their age and their associated medical conditions.

Materials and Methods

We studied 111 patients who were over 65 years old and they were able to be followed up for more than 3 months after performing posterior arthrodesis during the recent 5 years. Sixty-one patients who had undergone posterolateral fusion (PLF) were classified as group A, and 50 patients who had undergone posterior lumbar interbody fusion (PLIF) using a PEEK cage were classified as group B. We analyzed their rates of complications and the causative factors, according to operative methods and age, and these complications occurred within 12 weeks after the operations.

Results

Complications occurred for 43 patients of group A, and for 26 patients of group B. The differences in the rates of complications were statistically significant, and group A had a more complications than did group B. The relations between medical problems and the incidence of perioperative complications were statistically significant for both groups.

Conclusions

Elderly patients with medical problems should be made aware that they are at an increased risk for surgical complications, and attention should be paid to controlling the blood loss and limiting the operative time. The PLIF using a PEEK cage was identified as a procedure that could reduce the perioperative complications.

REFERENCES

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Table 1.
Demographic Characteristics of The Patients
  Group A Group B Significance (P)
Cases (No) 61 50  
Sex (M:F) 30:31 25:25 0.67 (C)
Age (years) 71.7±5.5 70.4±4.7 0.48 (I)
Fusion level (1 level:2 level) 20:41 30:20 0.35 (C)
Preoperative Diagnosis      
LSS 38 34  
LSS with SLT 15 13 0.59 (C)
LSS with Scoliosis 8 3  

LSS: Lumbar spinal stenosis, SLT: Spondylolisthesis, C: Chi-square test, I: Independent sample T-test

Table 2.
Perioperative Complications Associated with Posterior Arthrodesis
Major Complications Group A (%) Group B (%)
Wound infection 4 (15.4) 1 (10.0)
Pneumonia 1 (03.8) 1 (10.0)
Renal failure 3 (11.5) 3 (30.0)
Gastric ulcer 2 (07.7) 0 (00.0)
Respiratory distress 3 (11.5) 2 (20.0)
Neurologic deficit 1 (03.8) 2 (20.0)
Congestive heart failure 2 (07.7) 0 (00.0)
DIC or Massive TF 10 (38.5)0 1 (10.0)
Chi-square test: P=0.05
DIC: Disseminated Intravascular Coagulopathy, TF: Transfusion
Minor Complications Group A (%) Group B (%)
Urinary tract infection 10 (41.6)0 9 (42.9)
Anemia requring transfusion 4 (16.7) 7 (33.3)
Delirium 5 (20.8) 5 (23.8)
Arrythmia 0 (00.0) 2 (09.5)
Transient hypoxia 4 (16.7) 6 (28.6)
Wound seroma/hematoma 1 (04.2) 1 (04.8)

Chi-square test: P=0.41

Table 3.
Preoperative Comorbidities and Complications in Patients Group A and B
Comorbidities Group A (%) Group B (%) Complicated Case (%)
Hypertension 13 (43.3)0 21 (75.0)0 30 (88.2)
Diabetes mellitus 12 (40.0)0 14 (50.0)0 24 (92.3)
Cardiac problem 4 (13.3) 2 (7.1) 3 (50.0)
COPD 2 (6.7) 1 (3.6) 3 (100)
Asthma 2 (6.7) 1 (3.6) 3 (100)
Liver problem 2 (6.7) 2 (7.1) 0 (0)
Hyporthyroidism 2 (6.7) 1 (3.6) 0 (0)
Arrythmia 0 (0.0) 1 (3.6) 1 (100)
Cholecystitis 0 (0.0) 1 (3.6) 0 (0)

Chi-square test, P=0.62

Table 4.
Operative Time and Bleeding Amount Between Group A and B
Group Operative Time (min) Bleeding Amount (ml)
Group A 182.79±33.97 2187.54±766.09
Group B 168.58±39.22 1779.28±658.84
Significance (P) P=0.02 P=0.03
Group A and B with complications 199.39±30.79 2438.12±560.26
Group A and B without complications 138.16±16.14 1285.12±428.28
Significance (P) P=0.03 P=0.01
Group A with complications 200.23±30.18 2547.91±589.00
Group A without complications 141.11±18.75 1326.67±432.57
Significance (P) P=0.04 P=0.03
Group B with complications 198.21±32.32 2257.17±464.72
Group B without complications 135.91±13.77 1253.19±431.72
Significance (P) P=0.03 P=0.02

Independent sample T-test

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