Advertisement

Restoration of Thoracolumbar Spine Stability and Alignment in Elderly Patients Using Minimally Invasive Spine Surgery (MISS). A Safe and Feasible Option in Degenerative and Traumatic Spine Diseases

  • Giuseppe M. V. BarbagalloEmail author
  • Giuseppe Raudino
  • Massimiliano Visocchi
  • A. Abdulrazzaq Alobaid
  • A. Abdulaziz Al-Mutair
  • Thomas Naveen
  • Francesco Certo
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 124)

Abstract

Minimally invasive spine surgery (MISS), including percutaneous pedicle-screw fixation (PPSF), mini-open transforaminal lumbar interbody fusion (m-open TLIF), vertebroplasty, and stentoplasty, allows the preservation of neurological function and the restoration of spine stability, while reducing associated risks and complications. This study aimed to analyze the safety and efficacy of MISS in elderly patients suffering from degenerative or traumatic thoracolumbar diseases. Forty-five patients (28 females), with a mean age of 73 years (range 65–89), suffering from osteoporotic vertebral fractures (24), degenerative spondylolisthesis (15), and lumbar canal stenosis with instability and/or de novo scoliosis (6) were included.

Twenty-one patients underwent PPSF and m-open TLIF. The remaining patients received PPSF without interbody fusion, and in six of these fenestrated screws were used for vertebral body cement augmentation.

Functional evaluation was obtained with a visual analog scale (VAS) and the Oswestry Disability Index (ODI) pre- and postoperatively. Preoperative imaging included X-rays, computed tomography (CT), and magnetic resonance imaging (MRI). Patients were followed-up with X-rays, and a CT scan was also obtained at the last follow-up. Follow-up ranged from 6 to 59 months (mean 28 months). Follow-up CT scan documented intersomatic fusion in only 14 % of patients treated with m-open TLIF. Despite the high incidence of non-union, mean VAS and ODI scores showed a significant improvement, with a reduction of mean VAS from 9 to 4 and a reduction of mean ODI from 76.33 to 38.15 %. Only three patients developed postoperative complications. No patients showed neurological deficits.

Minimally invasive spine surgery for degenerative and traumatic spinal diseases is a safe and effective treatment also in elderly patients.

Keywords

Oswestry Disability Index Degenerative Spondylolisthesis Osteoporotic Vertebral Fracture Spinal Canal Stenosis Oswestry Disability Index Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of Interest Statement

We declare that we have no conflicts of interest.

References

  1. 1.
    Whitehouse MK, Jeyaretna DS, Wright A, Whitfield PC (2015) Neurosurgical care in the elderly: increasing demands necessitate future healthcare planning. World Neurosurg. doi: 10.1016/j.wneu.2015.10.099 [Epub ahead of print]Google Scholar
  2. 2.
    Barbagallo GM, Certo F, Sciacca G, Albanese V (2013) Bilateral tubular minimally invasive approach for decompression, reduction and fixation in lumbosacral lythic spondylolisthesis. Neurosurg Focus 35(2 Suppl):Video 9Google Scholar
  3. 3.
    Barbagallo GM, Piccini M, Alobaid A, Al-Mutair A, Albanese V, Certo F (2014) Bilateral tubular minimally invasive surgery for low-dysplastic lumbosacral lytic spondylolisthesis (LDLLS): analysis of a series focusing on postoperative sagittal balance and review of the literature. Eur Spine J 23 Suppl 6:705–713CrossRefPubMedGoogle Scholar
  4. 4.
    Barbagallo GM, Certo F, Visocchi M, Sciacca G, Piccini M, Albanese V (2015) Multilevel mini-open TLIFs and percutaneous pedicle screw fixation: description of a simple technical nuance used to increase intraoperative safety and improve workflow. Tips and tricks and review of the literature. Neurosurg Rev 38:343–354CrossRefPubMedGoogle Scholar
  5. 5.
    Deukmedjian AR, Ahmadian A, Bach K, Zouzias A, Uribe JS (2013) Minimally invasive lateral approach for adult degenerative scoliosis: lessons learned. Neurosurg Focus 35(2):E4CrossRefPubMedGoogle Scholar
  6. 6.
    Park P, Wang MY, Lafage V, Nguyen S, Ziewacz J, Okonkwo DO, Uribe JS, Eastlack RK, Anand N, Haque R, Fessler RG, Kanter AS, Deviren V, La Marca F, Smith JS, Shaffrey CI, Mundis GM Jr, Mummaneni PV, International Spine Study Group (2015) Comparison of two minimally invasive surgery strategies to treat adult spinal deformity. J Neurosurg Spine 22(4):374–380CrossRefPubMedGoogle Scholar
  7. 7.
    Drazin D, Shirzadi A, Rosner J, Eboli P, Safee M, Baron EM, Liu JC, Acosta FL Jr (2011) Complications and outcomes after spinal deformity surgery in the elderly: review of the existing literature and future directions. Neurosurg Focus 31(4):E3CrossRefPubMedGoogle Scholar
  8. 8.
    Rosen DS, O’Toole JE, Eichholz KM, Hrubes M, Huo D, Sandhu FA, Fessler RG (2007) Minimally invasive lumbar spinal decompression in the elderly: outcomes of 50 patients aged 75 years and older. Neurosurgery 60(3):503–510CrossRefPubMedGoogle Scholar
  9. 9.
    Acosta FL Jr, McClendon J Jr, O’Shaughnessy BA, Koller H, Neal CJ, Meier O, Ames CP, Koski TR, Ondra SL (2011) Morbidity and mortality after spinal deformity surgery in patients 75 years and older: complications and predictive factors. J Neurosurg Spine 15:667–674CrossRefPubMedGoogle Scholar
  10. 10.
    Lee JH, Chun HJ, Yi HJ, Bak KH, Ko Y, Lee YK (2012) Perioperative risk factors related to lumbar spine fusion surgery in Korean geriatric patients. J Korean Neurosurg Soc 51:350–358CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Daubs MD, Lenke LG, Cheh G, Stobbs G, Bridwell KH (2007) Adult spinal deformity surgery. Complications and outcomes in patients over Age 60. Spine 32(20):2230–2244CrossRefGoogle Scholar
  12. 12.
    Pesenti S, Blondel B, Peltier E, Adetchessi T, Dufour H, Fuentes S (2014) Percutaneous cement-augmented screws fixation in the fractures of the aging spine: is it the solution? Biomed Res Int 2014:610675CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Vishnubhotla S, McGarry WB, Mahar AT, Gelb DE (2011) A titanium expandable pedicle screw improves initial pullout strength as compared with standard pedicle screws. Spine J 11(8):777–781CrossRefPubMedGoogle Scholar
  14. 14.
    Schonauer C, Bocchetti A, Barbagallo G, Albanese V, Moraci A (2004) Positioning on surgical table. Eur Spine J. 13 Suppl 1:S50–55Google Scholar
  15. 15.
    Murthy S, Hepner DL, Cooper Z, Bader AM, Neuman MD (2015) Controversies in anaesthesia for noncardiac surgery in older adults. Br J Anaesth 115(Suppl 2):15–25CrossRefGoogle Scholar
  16. 16.
    Holly LT, Schwender JD, Rouben DP, Foley KT (2006) Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications. Neurosurg Focus 20(3):E6CrossRefPubMedGoogle Scholar
  17. 17.
    Wang J, Zhou Y, Zhang ZF, Li CQ, Zheng WJ, Liu J (2010) Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Eur Spine J 19:1780–1784CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Khan NR, Clark AJ, Lee SL, Venable GT, Rossi NB, Foley KT (2015) Surgical outcomes for minimally invasive vs open transforaminal lumbar interbody fusion: an updated systematic review and meta-analysis. Neurosurgery 77(6):847–874CrossRefPubMedGoogle Scholar
  19. 19.
    Lee DY, Jung TG, Lee SH (2008) Single-level instrumented mini-open transforaminal lumbar interbody fusion in elderly patients. J Neurosurg Spine 9(2):137–144CrossRefPubMedGoogle Scholar
  20. 20.
    Shamji MF, Goldstein CL, Wang M, Uribe JS, Fehlings MG (2015) Minimally invasive spinal surgery in the elderly: does It make sense? Neurosurgery 77(Suppl 4):S108–415CrossRefPubMedGoogle Scholar
  21. 21.
    Gu Y, Zhang F, Jiang X, Jia L, McGuire R (2013) Minimally invasive pedicle screw fixation combined with percutaneous vertebroplasty in the surgical treatment of thoracolumbar osteoporosis fracture. J Neurosurg Spine 18:634–640CrossRefPubMedGoogle Scholar
  22. 22.
    Bach K, Ahmadian A, Deukmedjian A, Uribe JS (2014) Minimally invasive surgical techniques in adult degenerative spinal deformity: a systematic review. Clin Orthop Relat Res 472(6):1749–1761CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Lee JK, Jang JW, Kim TW, Kim TS, Kim SH, Moon SJ (2013) Percutaneous short-segment pedicle screw placement without fusion in the treatment of thoracolumbar burst fractures: is it effective?: comparative study with open short-segment pedicle screw fixation with posterolateral fusion. Acta Neurochir 155:2305–2312CrossRefPubMedGoogle Scholar
  24. 24.
    Van Middendorp JJ, Barbagallo G, Schuetz M, Hosman AJF (2012) Design and rationale of a Prospective, Observational European Multicenter study on the efficacy of acute surgical decompression after traumatic Spinal Cord Injury: the SCI-POEM study. Spinal Cord. 50(9):686–694Google Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Giuseppe M. V. Barbagallo
    • 1
    Email author
  • Giuseppe Raudino
    • 1
  • Massimiliano Visocchi
    • 2
  • A. Abdulrazzaq Alobaid
    • 3
  • A. Abdulaziz Al-Mutair
    • 3
  • Thomas Naveen
    • 3
  • Francesco Certo
    • 1
  1. 1.Department of Neurological SurgeryPoliclinico “G. Rodolico” University HospitalCataniaItaly
  2. 2.Insitute of Neurosurgery, Medical SchoolCatholic University of RomeRomeItaly
  3. 3.Department of Spine SurgeryAl-Razi HospitalKuwaitKuwait

Personalised recommendations