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Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability
Published on: July 25, 2025
Risk Factors for Postoperative Cognitive Dysfunction Following Multilevel Lumbar Spinal Fusion.
Mladen Djurasovic1, Steven D Glassman1, Justin Mathew1
1Norton Leatherman Spine Center, Louisville, KY.
Spine
|June 10, 2025
Summary
Postoperative cognitive dysfunction (POCD) affects 12.4% of patients after spine fusion, linked to age, comorbidities, and intraoperative instability. Optimizing these factors may reduce POCD incidence.
Area of Science:
- Neurosurgery
- Anesthesiology
- Geriatric Medicine
Background:
- Postoperative cognitive dysfunction (POCD) is a significant complication in elderly surgical patients.
- Risk factors for POCD are varied, including pre-operative and intra-operative elements.
Purpose of the Study:
- To determine the incidence of POCD following multilevel spine fusion.
- To identify risk factors associated with POCD in this patient population.
Main Methods:
- Retrospective cohort study of 566 thoracolumbar fusion cases (≥4 levels).
- Chart review for POCD occurrence and risk factors, including anesthetic and surgical data.
- Analysis of mean arterial pressure (MAP) and cumulative hypotension duration.
- Statistical analysis to investigate demographic, pre-operative, and intra-operative risk factors.
Main Results:
- 12.4% (70/566) of patients developed POCD, primarily as encephalopathy.
- POCD patients were older, had higher BMI, worse ASA scores, and more comorbidities (diabetes, sleep apnea).
- Intraoperative factors included greater blood loss, transfusion, hypotension duration, and vasopressor use in POCD patients.
Conclusions:
- POCD incidence following multilevel spine fusion is 12.4%.
- Age, preoperative comorbidities, and intraoperative hemodynamic instability are associated with POCD.
- Optimizing these modifiable factors before surgery may reduce POCD rates.
