Instrumented posterolateral fusion - clinical and functional outcome in elderly patients

Data on the clinical outcome after spinal fusion in the elderly patient are rare. Limitation of most studies were small population, evaluation of the perioperative complication rate and the radiographic assessment. Therefore the aim of the current study was to evaluate the clinical outcome of patients older than 75 years who underwent a spinal fusion procedure (instrumentation and posterolateral fusion) for degenerative spinal stenosis with instability.

Elderly patients who underwent instrumented, posterolateral fusion were evaluated with regard to functional outcome, fusion rates and complications after a mean follow-up of 3.8 years. Questionnaires were completed by the patients before surgery and at final follow-up. Changes in mean visual analogue scale (VAS) and Owestry Disability Index (ODI) scores (decrease from the baseline VAS and ODI scores) were evaluated.

The mean final follow-up for all subjects was 3.8 years. Of the 58 patients, 1 patient was deceased at the time of the follow-up, 1 patient did not want to participate and 56 patients completed the questionnaires. This resulted in an overall follow-up rate of 96%.At final follow-up, the patients demonstrated significant improvement in the VAS and ODI scores compared with the preoperative scores.

The results of this study shows that elderly patients aged over 75 benefit from instrumented, posterolateral fusion. The study suggests that there is no need to force an intervertebral fusion because elderly patients do not seem to benefit from this procedure.