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 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 hould 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.
Subject(s)
Aged , Humans , Arthrodesis , Decompression , Incidence , Ketones , Operative Time , Polyethylene Glycols , Retrospective Studies , Risk Factors , SpineABSTRACT
The Graf system has supposed advantages with its flexible nature, as compared with rigid fixation. But there have been no reports about effects in the adjacent motion segment after soft stabilization. The purpose of this study was to evaluate the radiologic changes occuring in the adjacent segments of the Graf system and to assess its ability stabilizing the lumbar spine. A retrospective review of radiographs and medical records was undertaken in 32 cases who had been treated with the Graf system in degenerative lumbar spinal disorders. The average age at operation was 52.5 years and the average follow up period was 49.6 months. The results of this study were as follows: clinical assesments based on the Kirkaldy-Willis criteria revealed excellent in 13 cases (40.6%), good in 16 cases (50%), fair in 2 cases (6.3%) and poor in 1 case (3.1%). Radiologically we analysed the adjacent segments in 25 cases except the cases which did not have the correspondence between the clinical findings and the radiological findings, and the fixated segments in 32 cases. The acceleration of degenerative changes were found in the above adjacent segments in 11 cases (44%) and in the below adjacent segments in 5 cases (27.7%). Also, those changes were found in the fixated segments with discectomy in 19 cases (50%) and in the fixated segments without discectomy in 9 cases (37.5%). In conclusion, we think that the Graf system in a lumbar region may biomechanically influence the adjacent segments. The mechanical effects of the device could be changed by the polyester bands which were followed for a longer period of time in the fixated segments. Therefore, randomized prospective studies comparing the Graf system to other treatement methods could provide clear indications for lumbar spinal disorders.