Efficacy analysis of posterior decompression and interbody fusion in the treatment of lumbar degenerative diseases in elderly patients with HIV infection

English Keywords:Lumbar degenerative diseases  Human immunodeficiency virus  Elderly  Posterior decompression and interbody fusion  Curative effect

English Abstract:

  【Abstract】 Objectives: To explore the efficacy of posterior decompression and interbody fusion in the treatment of lumbar degenerative diseases in elderly patients with human immunodeficiency virus(HIV) infection. Methods: The clinical data of 25 elderly patients(≥65 years old) with HIV infection who were treated with posterior decompression and interbody fusion(as HIV group) in the Department of Orthopedics, Beijing Ditan Hospital affiliated to Capital Medical University from January 2015 to October 2021 were retrospectively analyzed. Another 35 cases of elderly non-HIV infected patients who received posterior decompression and interbody fusion for lumbar degenerative diseases in the same period and were matched with HIV group in age, sex, duration of symptoms, type of degenerative disease, type and severity of underlying diseases, fusion type, and decompression type, were selected as the non-HIV group. Lumbar bone mineral density(BMD), CD4+ T lymphocyte count, CD4+ T lymphocyte count/CD8+ T lymphocyte count, body mass index(BMI), albumin, hemoglobin and co-infection were compared between HIV group and non-HIV group before operation. Both groups were given perioperative standardized management and long-term health management after discharge. Visual analogue scale(VAS) of low back and leg pain, lumbar Oswestry disability index(ODI), Japanese Orthopaedic Association(JOA) score of lumbar spine, and bone graft fusion were observed before operation and at 6 months and 12 months postoperatively. Intraoperative and postoperative complications were collected. The changes of hip BMD between before operation and at 6 months and 12 months postoperatively in HIV group were counted. Results: Both groups of patients underwent surgery smoothly, with an operative time of 147.16±6.58min and a bleeding volume of 319.16±26.84ml in HIV group, and an operative time of 145.31±9.77min and a bleeding volume of 309.69±24.43ml in non-HIV group. The lumbar BMD, CD4+ T lymphocyte count, CD4+ T lymphocyte count/CD8+ T lymphocyte count, BMI, albumin and hemoglobin in HIV group were significantly lower than those in non-HIV group before operation(P<0.05). The number of patients with infection(hepatitis B, hepatitis C, and syphilis) in HIV group was significantly higher than that in non-HIV group(P<0.05). The VAS, ODI and JOA scores of both groups showed continuous improvement at 6 months and 12 months postoperatively than before operation(P＜0.05). The VAS, ODI and JOA scores in HIV group were significantly higher than those in non-HIV group before operation and at 6 months postoperatively(P＜0.05), while no significant differences was found between the two groups at 12 months postoperatively(P＞0.05). The BMD of hip in HIV group increased continuously at 6 months and 12 months postoperatively than before operation(P＜0.05). HIV group was followed up for 19.38±3.62 months(12-30 months), and non-HIV group was followed up for 22.89±4.12 months(12-36 months), with no significant difference between the two groups(P>0.05). Bony fusion of lumbar vertebra was achieved in both groups at the last follow-up, and there were no intraoperative and postoperative complications such as dural tear, surgical site infection, opportunistic infection or internal fixation loosening related ones. Conclusions: Elderly patients with lumbar degenerative diseases complicated with HIV infection have low lumbar BMD, poor immunity and nutritional status, and multiple infectious diseases (hepatitis B, hepatitis C, syphilis); Posterior decompression and interbody fusion is a safe and effective treatment for such population on the basis of perioperative standardized management and long-term health management after discharge.