Skip to main content

Complication rate during multilevel lumbar fusion in patients above 60 years

Indian Journal of Orthopaedics volume 51, pages 139–146 (2017)Cite this article

Abstract

Background

Spine surgery in elderly with comorbidities is reported to have higher complication rates and increased cost. However, the surgical outcome is good irrespective of the complications. Hence, it is essential to identify the factors affecting the complication rates in such patients and the measures to reduce them. This retrospective observational study determines the perioperative complications, their incidence and the measures to reduce complications in the elderly with comorbidities, operated by instrumented multilevel lumbar fusion.

Materials and Methods

Patients aged 60 years and above with one or more comorbidities operated by multilevel instrumented lumbar fusion in our center between January 2012 and December 2013 were included in the study. Perioperative complications and their incidence were calculated. Age, number of levels fused, operative time, blood loss, and complication rates were correlated with the duration of stay and the incidence of perioperative complications using SPSS software. Measures to reduce complications are determined by these results and by review of literature.

Results

Fifty two patients were included in the study (28 females and 24 males) with an average age of 69 years (range 60–84 years). Hypertension was the most common comorbidity followed by diabetes. Spondylolisthesis was the most common indication. Eleven complications were noted with an incidence of 21%. Three were systemic complications which required transfer to Intensive Care Unit. Local complications were incidental durotomy (three), transient root deficits (two), wound infections (one), and persistent radicular pain (two). Operative time and blood loss were significantly higher in patients with complications.

Conclusion

Complication rates strongly correlate with the blood loss and operative time. Reducing the operative time and blood loss by intraoperative tranexamic acid, laminectomy using osteotome, simultaneous bilateral exposure and instrumentation and reducing the number of interbody fusions can help in reducing the complications.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. U. S. Census Bureau DIS. 2008 National Population Projections: Summary Tables [Internet]. Available from: http://www.census.gov/population/projections/data/national/2008/summarytables. html. [Last cited 2016 Oct 14].

  2. MCRC: Epidemiology of Spinal Surgery - Comparative Effectiveness, Cost and Outcomes Research Center - University of Washington [Internet]. Available from: http://depts.washington.edu/ccor/studies/SpineSurgEpi.shtml. [Last cited 2016 Oct 14].

  3. Epstein NE. Spine surgery in geriatric patients: Sometimes unnecessary, too much, or too little. Surg Neurol Int 2011;2:188.

    Article  Google Scholar 

  4. Acosta FL Jr., McClendon J Jr., O’Shaughnessy BA, Koller H, Neal CJ, Meier O, et al. Morbidity and mortality after spinal deformity surgery in patients 75 years and older: Complications and predictive factors. J Neurosurg Spine 2011;15:667–74.

    Article  Google Scholar 

  5. Campbell PG, Yadla S, Nasser R, Malone J, Maltenfort MG, Ratliff JK. Patient comorbidity score predicting the incidence of perioperative complications: Assessing the impact of comorbidities on complications in spine surgery. J Neurosurg Spine 2012;16:37–43.

    Article  Google Scholar 

  6. Daubs MD, Lenke LG, Cheh G, Stobbs G, Bridwell KH. Adult spinal deformity surgery: Complications and outcomes in patients over age 6. Spine (Phila Pa 1976) 2007;32:2238–44.

    Article  Google Scholar 

  7. Sanderson PL, Wood PL. Surgery for lumbar spinal stenosis in old people. J Bone Joint Surg Br 1993;75:393–7.

    Article  CAS  Google Scholar 

  8. Ragab AA, Fye MA, Bohlman HH. Surgery of the lumbar spine for spinal stenosis in 118 patients 70 years of age or olde. Spine (Phila Pa 1976) 2003;28:348–53.

    Google Scholar 

  9. Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am 1991;73:802–8.

    CAS  PubMed  Google Scholar 

  10. Guigui P, Devyver B, Rillardon L, Ngounou P, Deburge A, Ghosez JP. Intraoperative and early postoperative complications of lumbar and lumbosacral fusion: Prospective analysis of 872 patients. Rev Chir Orthop Reparatrice Appar Mot 2004;90:5–15.

    Article  CAS  Google Scholar 

  11. Carreon LY, Puno RM, Dimar JR 2nd, Glassman SD, Johnson JR. Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am 2003;85-A:2089–92.

    Article  Google Scholar 

  12. Cho KJ, Suk SI, Park SR, Kim JH, Kim SS, Choi WK, et al. Complications in posterior fusion and instrumentation for degenerative lumbar scoliosi. Spine (Phila Pa 1976) 2007;32:2232–7.

    Article  Google Scholar 

  13. Zimmerman RM, Mohamed AS, Skolasky RL, Robinson MD, Kebaish KM. Functional outcomes and complications after primary spinal surgery for scoliosis in adults aged forty years or older: A prospective study with minimum two-year followu. Spine (Phila Pa 1976) 2010;35:1861–6.

    Article  Google Scholar 

  14. Sakaura H, Yamashita T, Miwa T, Ohzono K, Ohwada T. Outcomes of 2-level posterior lumbar interbody fusion for 2-level degenerative lumbar spondylolisthesis. J Neurosurg Spine 2013;19:90–4.

    Article  Google Scholar 

  15. Lykissas MG, Crawford AH, Chan G, Aronson LA, Al-Sayyad MJ. The effect of tranexamic acid in blood loss and transfusion volume in adolescent idiopathic scoliosis surgery: A singlesurgeon experience. J Child Orthop 2013;7:245–9.

    Article  Google Scholar 

  16. Okuda S, Oda T, Miyauchi A, Haku T, Yamamoto T, Iwasaki M. Surgical outcomes of posterior lumbar interbody fusion in elderly patients. Surgical technique. J Bone Joint Surg Am 2007;89 Suppl 2 (Pt 2):310–20.

    Google Scholar 

  17. De Rojas JO, Syre P, Welch WC. Regional anesthesia versus general anesthesia for surgery on the lumbar spine: A review of the modern literature. Clin Neurol Neurosurg 2014;119:39–43.

    Article  Google Scholar 

  18. McLain RF, Bell GR, Kalfas I, Tetzlaff JE, Yoon HJ. Complications associated with lumbar laminectomy: A comparison of spinal versus general anesthesi. Spine (Phila Pa 1976) 2004;29:2542–7.

    Article  Google Scholar 

  19. Nicassio N, Bobicchio P, Umari M, Tacconi L. Lumbar microdiscectomy under epidural anaesthesia with the patient in the sitting position: A prospective study. J Clin Neurosci 2010;17:1537–40.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Spine Surgery, Jain Institute of Spine Care and Research, Bhagwan Mahaveer Jain Hospital, Millers Road, Vasanthnagar, Bengaluru, 560 052, Karnataka, India

    Bijjawara Mahesh, Bidre Upendra, S. Vijay, G. C. Arun Kumar & Srinivas Reddy

Authors
  1. Bijjawara Mahesh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bidre Upendra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Vijay
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. C. Arun Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Srinivas Reddy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Vijay.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mahesh, B., Upendra, B., Vijay, S. et al. Complication rate during multilevel lumbar fusion in patients above 60 years. IJOO 51, 139–146 (2017). https://doi.org/10.4103/0019-5413.201704

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/0019-5413.201704

Key words

  • Comorbidities
  • lumbar fusion
  • geriatrics
  • spine

MeSH terms

  • Geriatrics
  • spinal fusion
  • degenerative diseases
  • spondylolisthesis
  • lumbar vertebrae