Article
Influence of high age and associated comorbidity on functional outcome of posterior lumbar interbody fusion (PLIF) for degenerative pseudolisthesis
Einfluss höheren Lebensalters und assoziierter Komorbidität auf das funktionelle Outcome der posterioren lumbalen interkorporellen Fusion (PLIF) bei degenerativer Pseudolisthese
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Published: | April 23, 2004 |
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Outline
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Objective
To investigate the specific influence of age and associated medical comorbidity (e.g., cardiopulmonary diseases, diabetes) on clinical, social and radiological results in patients ≥65 years of age with significant comorbidity (group A) receiving PLIF for mono- or bisegmental degenerative lumbar pseudolisthesis (DLP; Meyerding grades I&II) as compared to a reference population (≤65 years, no significant comorbidity; group B).
Methods
A total of 62 consecutive patients (20 patients ≥65 years) undergoing mono- or bisegmental PLIF using pedicle screw-rod systems and interbody PEEK cages were prospectively evaluated using the AAOS lumbar spine outcomes instrument and Roland-Morris low back pain questionnaire. Following preoperative evaluation, functional outcome was assessed by 3, 6 and 12 months. Progression to solid bony fusion was evaluated by radiographic controls at 6 and 12 months.
Results
In group A, 10 patients (50%) experienced perioperative problems such as delayed wound healing (mainly due to significant obesity), 4 patients (20%) developed clinical symptoms from early adjacent segment degeneration. In contrary, only 1 (significantly obese) patient of group B experienced delayed wound healing; early degeneration of adjacent segments was not observed. All patients (groups A and B) went on to achieve solid bony fusion of the instrumented segments. AAOS and Roland-Morris scores improved significantly (P<0.05) in both groups, with slightly better results in the control group (P>0.05).
Conclusions
While perioperative risks increased significantly in patients ≥65 years with significant comorbidity (especially in obese patients), functional outcomes of PLIF for DLP in this group were comparable to the control group. In monosegmental fusion, clinically manifest early adjacent segment degeneration was found in elderly patients only. Despite the specific problems encountered in elderly patients, PLIF for DLP appears to be a viable treatment option even in high-aged patients with significant medical comorbidity.