Effectiveness of midline lumbar fusion with cortical bone trajectory screw fixation for degenerative lumbar spine disease in geriatric patients over 80 years old: a single-center, one-decade experience

Abstract

Objective: We aimed to retrospectively analyze clinical and surgical outcomes following posterior lumbar interbody fusion with concomitant pedicle screw fixation, midline lumbar fusion, and decompressive laminectomy in patients aged 80 years or older with degenerative lumbar spine disease.Methods: The study group comprised 94 patients aged 80 years or older who received degenerative lumbar spinal surgery at our spine center from January 2011 to December 2020. Among them, 28 patients underwent decompressive laminectomy, 19 underwent posterior lumbar interbody fusion with pedicle screw fixation, and the remaining 47 underwent midline lumbar fusion.Results: No significant intergroup differences were found regarding age, sex ratio, follow-up duration, and surgical level. The visual analog scale for lower back pain on postoperative day 7 was significantly different among the groups (P<0.05). The Oswestry disability index was significantly different among the groups after 1 week of follow-up (P<0.05). The estimated blood loss and operation time also showed significant differences among the groups (P<0.05). There was a statistically significant difference among the groups in postoperative morbidity (P<0.05).Conclusion: Although the clinical outcomes were not significantly different among the three groups, perioperative morbidity was more favorable in the decompression and midline lumbar fusion groups. Therefore, we suggest that midline lumbar fusion is not inferior to posterior lumbar interbody fusion with pedicle screw fixation, if there is a need for fusion in elderly patients over 80 years of age.