The effect and complications of posterior lumbar decompression and fusion in geriatric patients with lumbar degenerative disease

English Keywords:Lumbar degenerative disease  Posterior lumbar decompression and fusion  Geriatric  Complications

English Abstract:

  【Abstract】 Objectives: To evaluate the effect and complications of posterior lumbar decompression and fusion in geriatric patients with lumbar degenerative disease by retrospective analysis of the medical data. Methods: From January 2015 to October 2018, a total of 268 patients aged 75 and above received lumbar posterior decompression and fusion surgery due to lumbar degenerative diseases in our hospital. Among them, 230 patients were followed up for no less than 12 months(12-51 months, a mean of 23.4±8.0 months) with complete follow-up data. The average age of the patients was 77.3±2.2 years old(ranged 75-84 years old). There were 60 cases of single segmental surgery, 114 cases of two segmental surgery, and 56 cases of three or more segmental surgery. 192 patients had preoperative complications(83.5%). Each patient had 2.2 kinds of medical disease on average, with hypertension in 176(74.6%) patients, diabetes in 88(38.3%) patients, heart diseases in 48(20.9%) patients, cerebral infarction in 30 (13.0%) patients, pulmonary diseases in 26 (11.3%) patients, and tumor in 18(7.8%) patients. A total of 302 times of preoperative medical consultation were conducted, with an average of 1.3 times for each patient. 70 patients(30.4%) underwent root block before surgery required by their diagnoses, of which 24(10.4%) underwent two or more root block. Operation time, intraoperative blood loss and postoperative complications were collected. Visual analogue scale(VAS) and Oswestry disability index(ODI) were used for evaluation at pre-operation, 3 months after surgery and final follow-up. Results: All 230 patients were operated and discharged. The operation time was 120-380min (range, 233.1±67.3min), and the intraoperative blood loss was 150-600ml(range, 304.5±92.4ml). At pre-operation, the VAS score of waist was 7.2±1.2 points, and 6.6±1.7 points of lower limb. At 3 months after surgery, the VAS score of waist was 3.4±0.5 points, and 3.3±0.5 points of the lower limb. At final follow-up, the VAS score of waist was 1.8±0.4 points, and 1.7±0.5 points of the lower limb. The preoperative ODI was (57.1±10.5)%. At 3 months after surgery, the ODI score was (19.3±3.0)%, and at final follow-up it was (11.4±1.7)%. The postoperative VAS score and ODI were significantly improved compared with that preoperatively(P<0.05). The overall incidence of postoperative complications was 28.7%, with 30 cases (13.0%) of operation-related complications, which included 14 cases of dural tear, 8 cases of poor incision healing, 6 cases of cerebrospinal fluid leakage, 1 case of incision infection, and 1 case of nerve root injury (due to poor screw position, recovery after adjustment). 36 cases(15.7%) of non-surgical complications, including 12 cases of intestinal obstruction, 8 cases of urinary tract infection, 6 cases of urinary retention, 4 cases of pendular pneumonia, 4 cases of cerebral infarction, and 2 cases of deep vein thrombosis. At final follow-up, no screw and titanium rod fracture found besides 2 patients showed screw looseness. Conclusions: Patients aged 75 years or above with lumbar degenerative diseases have more preoperative complications, more complicated perioperative preparation and higher incidence of postoperative complications. On the basis of systematic preoperative preparation, patients aged 75 years or above with lumbar degenerative diseases can obtain satisfactory results through surgical treatment.