Background: With improvement of health care in last decades, the age of general population increased. As the
elderly with degenerative lumbar disease needs to remain physically active for more years, lumbar decompression
surgery with instrumented fusion is further considered and is gaining wide acceptance as it provides good results
with relative minimal risk. This study aim to evaluate the safety and efficacy of lumbar decompression with
instrumented fusion in elderly
Results: This is a prospective non-randomized clinical study conducted from July 2014 to July 2019. The included
patients had chronic low back pain, radiculopathy, and/or neurogenic claudication due to degenerative lumbar
disease with failed conservative management. They underwent lumbar decompression with instrumented
posterolateral fusion. All patients were at least 55 years old at time of surgery and were clinically assessed as regard
perioperative risk and morbidity, besides assessment of pre- and postoperative visual analog score (VAS) and
Oswestry Disability Index (ODI). Data was collected and analyzed. Thirty-five patients were included in this study
with mean age of 63 years. All patients presented with back pain, 77.1% with radiculopathy, and 60% with
neurogenic claudication. Preoperative comorbidity was present in 60% of cases, where hypertension, diabetes, and
cardiac troubles were 31.4%, 31.4%, and 14.3% respectively. The average operated level was 3.1. The complication
rate was 11.4% with 2 cases with dural tear (5.7%), 2 cases with CSF leakage (5.7%), 1 case with wound seroma
(2.8%), and 1 case with wound infection. Postoperative new comorbidity occurred in 5 cases (14.3%). Visual analog
score (VAS) and Oswestry disability index (ODI) were recorded preoperatively and 18 months postoperatively; as
regards pain, VAS improved significantly from 7.8 ± 0.87 to 1.8 ± 1.04 (P value< 0.00001), and ODI improved
significantly from 58.1 ± 11 to 17.5 ± 8.3 (P value< 0.00001).
Conclusion: Lumbar decompression surgery with posterolateral instrumented fusion is a safe and effective surgery
in elderly, as it provides significant results and gives them a chance for better quality of life. Preoperative
comorbidity could be dealt with, and it should not be considered as a contraindication for surgery in this age
group. |
