The therapeutic effect of different posterior circumferential fusion on lumbar instability in aged patients / 中华老年医学杂志

ABSTRACT

ObjectiveTo compare the clinical effect of posterior circumferential fusion with versus without intertransverse process fusion on lumbar instability in aged patients. MethodsThe elderly with lumbar instability were treated with the posterior instrumented circumferential fusion technique in 80 cases. Among 58 patients followed up for at least 2 years, 28 cases (group A)underwent posterior circumferential fusion with intertransverse process, while 30 cases (group B)without intertransverse process. X-ray examination was used before and 1, 3, 6, 12 and 24 months after operation to evaluate the fusion condition of the bone graft, and visul analogue scale (VAS) and Oswestry disability index (ODI) questionnaire were applied to assess the pain of center back and leg,and the conventional activity.ResultsThe operation time and blood loss were more in group A[(185.3±56.6) min and (376.3±92.9) m1] than in group B [(146.4±46.3) min and (234.3±64.5)ml (t=12.37, 37.49, P＜0.01)]. All the 58 cases were followed for at least 2 years. The 27 cases (96.4％) of group A and 28 cases (93.3％) of group B got bone fusion (x2 =0.004, P＞0.05).There were marked differences in the VAS of center back at 1 and 3 months after operation between the 2 groups (t=3.178, 2.158, both P＜0.05), while no difference at the other 3 time point. VAS about the leg pain and the ODI showed no differences between group A and B after operation (all P＞0.05). ConclusionsFor the lumbar instability in the elderly, the posterior circumferential fusion with or without intertransverse process fusion can achieve a similar high rate of fusion and satisfactory clinical results,andtheposteriorcircumferentialfusionwithoutintertranaverseprocess is recommended for less trauma.