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Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability
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Elderly as a Predictor for Perioperative Complications in Patients Undergoing Multilevel Minimally Invasive
Chad F Claus1, Evan Lytle, Doris Tong
1Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, MI.
Study Design:
This was a single-institute retrospective study.
Objective:
To describe perioperative and postoperative complications in elderly who underwent multilevel minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) while identifying predictors of complications.
Summary Of Background Data:
The number of elderly patients undergoing spinal fusion is rising. Spinal surgery in the elderly is considered high risk with high rates of complications. Perioperative and postoperative complications in elderly undergoing multilevel MIS TLIF is, however, not known.
Methods:
A retrospective analysis was performed on 467 consecutive patients who underwent multilevel MIS TLIF at a single institution from 2013 to 2017. Two cohorts, 70 years or older and 50 to 69 years old were analyzed. Multiple logistic regressions with minor and major complication rates as the dependent variables were performed to identify predictors of complication based on previously cited risk factors. A p-value of 0.008 or less was considered significant.
Results:
One hundred fifty-two elderly and 315 nonelderly patients underwent multilevel MIS TLIFs. The average age was 76.4 and 60.4 years for the elderly and nonelderly cohorts. We observed 13 major (8.44%) and 72 minor (47.4%) complications in the elderly. No difference was noted in complication rates between the cohorts, except for urinary tract infection (P = .004) and urinary retention (P = .014). There were no myocardial infarctions; hardware complications; visceral, vascular, and neural injuries; or death. Length of stay, comorbidity, and length of surgery were predictive of major and minor complications.
Conclusion:
Elderly may undergo multilevel MIS TLIF with comparable complication rates. Age was not a predictor of complications. Rather, attention should focus on evaluation of comorbidity and limiting operative times.
Level Of Evidence:
3.
Insights
Elderly patients can safely undergo multilevel minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Complication rates were comparable to younger patients, with comorbidity and operative time being key predictors.
Area of Science:
- Spine surgery
- Geriatric medicine
- Minimally invasive procedures
Background:
- The number of elderly patients undergoing spinal fusion is increasing.
- Spinal surgery in the elderly is associated with high complication rates.
- Complications of multilevel MIS TLIF in the elderly are not well-documented.
Purpose of the Study:
- To describe perioperative and postoperative complications in elderly patients undergoing multilevel MIS TLIF.
- To identify predictors of complications in this patient group.
Main Methods:
- Retrospective analysis of 467 patients undergoing multilevel MIS TLIF (2013-2017).
- Comparison of two cohorts: 70 years or older (elderly) and 50-69 years old (nonelderly).
- Logistic regression analysis to identify predictors of minor and major complications.
Main Results:
- 152 elderly and 315 nonelderly patients were analyzed.
- Elderly patients had 13 major (8.44%) and 72 minor (47.4%) complications.
- Complication rates were similar between groups, except for urinary tract infection and urinary retention. Age was not a predictor.
- Comorbidity and length of surgery predicted major and minor complications.
Conclusions:
- Elderly patients can undergo multilevel MIS TLIF with comparable complication rates.
- Age is not a predictor of complications; focus should be on comorbidity and operative time.
- Multilevel MIS TLIF is a viable option for elderly patients when comorbidities are managed and operative times are limited.
