Background Context: Despite the growing senior population within the United States, there is a lack of consensus regarding the safety and efficacy of performing lumbar spinal fusion for this population.
Purpose: To evaluate the clinical and radiographic outcomes in different age cohorts following lumbar spinal fusion.
Study Design: Retrospective cohort analysis.
Patient Sample: Analysis of 1,184 patients who underwent posterolateral lumbar fusion from 2011 to 2018. Surgery was indicated after failure of conservative treatment to address radiculopathy and/or neurogenic claudication. Patients were excluded if they were under 18 years of age at the time of surgery, had a lumbar fracture, tumor, or infection, or had fusions involving the thoracic spine, high-grade spondylolisthesis, or concomitant deformity. Of the 1,184 patients, 850 patients were included. Patients were divided into three roughly equal groups for analysis: young (18-54 years), middle-aged (55-69 years), and senior (≥70 years).
Outcome Measures: Visual Analog Scale Back/Leg pain, and Oswestry Disability Index (ODI) were collected, and achievement of minimal clinically important difference was evaluated. Lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and PI-LL difference were measured on radiographs. Rates of postoperative complications were analyzed.
Methods: Several radiographic parameters were measured using plain radiographs obtained at preoperative, immediately postoperative (standing radiographs performed on postoperative day 1), and most recent follow-up visits. Preoperative and final patient-reported outcomes, along with demographic information, were obtained all patients. Binary outcome variables were compared between groups with multivariate logistic regression, and continuous outcome variables were compared using multivariate linear regression, with age 18 to 54 years used as the reference. Multivariate regressions were used to compare outcomes between cohorts while controlling baseline characteristics.
Results: A total of 850 patients were included; 330 young (38.80%), 317 middle-aged (37.30%), and 203 senior (23.90%). Seniors had higher postoperative length of stay compared to younger patients (p<.001). Younger patients had worse final ODI scores compared to middle-aged patients (p=.002). Seniors had higher rates of proximal ASD (p=.002) compared to young patients. There was no difference in achievement of minimal clinically important differences (MCID) between all three groups.
Conclusions: Senior patients have significant improvement in patient-reported clinical outcomes, despite having greater comorbidities, and longer length of stay. However, given a general lack of achievement of MCID across all cohorts, these findings suggest the need for a critical re-evaluation of the role of lumbar spinal fusion in the management of patients with refractory radiculopathic and/or neurogenic claudication symptoms.
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http://dx.doi.org/10.1016/j.spinee.2019.11.003 | DOI Listing |
J Orthop Surg Res
December 2024
Spinal Ward, The 900th Hospital of Joint Logistic Support Force, PLA, 156 Xierhuan Northern Road, FuZhou, 350025, China.
Background: There is currently no consensus on the surgical treatment of lumbar spondylolysis in young adults, and the nonunion rate remains relatively high even after surgery. Therefore, in this study, we proposed a modified intravertebral screw-rod fixation technique within a single vertebral segment and investigated the clinical efficacy of this modified fixation system combined with autologous cancellous bone grafting in the treatment of lumbar spondylolysis in young adults.
Methods: This study included 28 young adults with lumbar spondylolysis who were treated at our center between 2021 and 2023.
World Neurosurg
December 2024
Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; McKenna EpiLog Fellowship in Population Health, at the University of Pennsylvania, Philadelphia, PA, USA. Electronic address:
Background: While studies have examined the relationship between sex and outcomes after lumbar fusion surgery, few have strictly controlled for other patient-level variables. In this study, we use coarsened exact matching to determine the effect of patient-reported sex on spinal fusion outcomes.
Methods: Outcomes across 4680 consecutive adult single-level, posterior-only lumbar fusions at a multihospital academic medical center were retrospectively assessed.
J Electromyogr Kinesiol
December 2024
School of Kinesiology, The University of British Columbia, 6108 Thunderbird Blvd, Vancouver, BC, V6T 1Z3, Canada. Electronic address:
The passive stiffness of the lumbar spine has direct implications on one's risk of injury and spinal instability. Therefore, the effects that physical activity lifestyle may have on the lumbar spine's passive stiffness was assessed. Participants were classified as active (n = 20) or inactive (n = 21) after completing a physical activity questionnaire.
View Article and Find Full Text PDFGait Posture
December 2024
Department of Orthopedic Surgery, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA. Electronic address:
Background: Back muscles simultaneously drive spinal movements and stabilize the trunk. Paraspinal muscle activity is presumed to be symmetric and gender-insensitive, and more activated with aging to protect the spine during functional tasks.
Research Question: Does over-activated and asymmetric behaviors exist in the pain-free elderly population which is affected by their physical activity levels?
Methods: Forty healthy participants (aged 64.
BMC Surg
December 2024
Department of Orthopedics & Elderly Spinal Surgery, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China.
Objective: Failure to understand long-term quality of life and functional outcomes hinders effective decision making and prognostication. Therefore, the study aims to predict and analyse the unfavorable outcomes (FOs) in elderly patients undergoing lumbar fusion surgery.
Methods: Consecutive 382 patients who underwent lumbar fusion surgery for lumbar degenerative disease from March 2019 to July 2022 were enrolled in this study.
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