Abstract
ObjectiveSurgical treatment of lumbar spinal stenosis (LSS) in octogenarians (patients aged ≥ 80 years) has been a challenge. Inter-spinal distraction fusion (ISDF)—a minimally invasive procedure—was used for treating LSS in octogenarians. This retrospective cohort study aimed to investigate the clinical efficacy and safety of a minimally invasive ISDF technique for LSS in octogenarian patients.MethodsFrom April 2015 to April 2019, octogenarian patients who underwent lumbar fusion surgery due to single-segment LSS were included. The patients were grouped into the ISDF group and posterior lumbar interbody fusion (PLIF) group based on the type of surgery. Clinical outcomes were evaluated using scores of the visual analog pain scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedics Association (JOA) scale. Radiographs were assessed for the intervertebral angle (IA), lumbar lordosis (LL), and posterior disc height (PDH). After 2 years postoperatively, all patients underwent computed tomography (CT) to evaluate the fusion condition. Perioperative data and related complications were recorded.ResultsSixty-two patients were included (mean age: 82.22 ± 1.95 years). The ISDF and the PLIF groups had 34 and 28 patients, respectively. The average follow-up time was 2.1 ± 0.25 years. There was no significant difference in VAS, ODI, JOA, and PDH scores between both groups preoperatively and at each postoperative time-point. The IA and LL showed significant differences between both groups after surgery (p < 0.05). The postoperative IA in the ISDF group were significantly lower than the preoperative values, while that in the PLIF group were markedly increased. The PLIF group had an increased LL compared with that preoperatively (p < 0.05), while the LL in the ISDF did not significantly change. The operative time, blood loss, hospital stay time, and the rate of perioperative complications of the ISDF group were significantly lower than those of the PLIF group (p < 0.05). There was no significant difference in the fusion rates between both groups.ConclusionISDF surgery is a viable method for octogenarian patients with LSS that provides a similar clinical efficacy, shorter operative time, less blood loss, shorter hospital stay time, and fewer complications, compared to the PLIF surgery.
Highlights
As medical technologies have advanced and public health establishments underwent improvements, longevity rates increased and led to the gradual increase in the population of elderly people in some industrial cities[1]
There were no significant differences in the age, sex, bone mineral density (BMD), symptom duration, Charlson comorbidity index (CCI), American Society of Anesthesiologists (ASA), stenosis degree, lesion segment, preoperative visual analog pain scale (VAS), preoperative Oswestry Disability Index (ODI), and preoperative Japanese Orthopedics Association (JOA) between both groups (Table 1)
The results demonstrated that Inter-spinal distraction fusion (ISDF) surgery had a similar clinical efficacy as posterior lumbar interbody fusion (PLIF) for octogenarians with Lumbar spinal stenosis (LSS)
Summary
As medical technologies have advanced and public health establishments underwent improvements, longevity rates increased and led to the gradual increase in the population of elderly people in some industrial cities[1]. Octogenarians (aged ≥ 80 years) comprise the fastest growing age group globally, which causes an increase in the incidence of age-related diseases, including lumbar disc herniation, stenosis, and spondylolisthesis[2]. Lumbar spinal stenosis (LSS) is a common age-related degenerative disease affecting the mobility of elderly persons with the classic characteristic of intermittent claudication[3]. Treatment options include conservative management (drug therapy, physiotherapy, or epidural steroid injections) and surgical intervention. Conservative management fails to show improvement require surgery[4]. The complexities of the health status increase the risk of surgery. For the management of octogenarian patients who require surgical decompression, a suitable surgical regimen needs to be developed after weighing the pros and cons
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