Introduction: Elderly patients undergoing traditional open spinal surgery are considered having high complication risk.1–3 Perioperative and postoperative complications risks for the elderly undergoing minimally invasive (MIS) multi-level transforaminal lumbar interbody (MLTLIF) fusion are not well studied.4–6 We sought to demonstrate that MIS MLTLIF can be safely performed in the elderly.

Methods: A retrospective analysis was performed on consecutive patients aged 70 or older who underwent ML (> 2 level) MIS TLIF at a single institution from 2013-2017. Patients were excluded if the surgery was performed for non-degenerative etiologies. Electronic Medical Records were analyzed for patient demographics, procedures, and perioperative and postoperative complications. Complications were defined as major or minor based on Carreon’s classification.2 Postoperative period was defined as 30 days after surgery and perioperative period was defined as the duration of hospitalization.

Results: One-hundred-fifty-four patients underwent MIS MLTIF. Their average age was 76.4 years (range 70-90). Patient demographics and perioperative characteristics are detailed in Table 1. We observed 13 major (8.44%) 74 minor (48.05%) complications (Table 2) with 67 patients (43.5%) experiencing at least one major or minor complication (Table 3). The 13 major complications included acute kidney injury (4/2.60%), wound seroma and/or hematoma (3/1.95%) requiring surgical evacuation, pneumonia (2/1.30%), pulmonary embolism (1/0.65%), epidural abscess (1/0.65%), respiratory distress (1/0.65%), and adjacent level fracture (1/0.65%). The primary minor complications which occurred were anemia requiring transfusion and urinary retention. There were no myocardial infarctions, hardware complications, major visceral, vascular, neural injuries, or death. The complication rate per fusion level is shown in table 4. Estimated blood loss for the number of levels fused is shown in Figure 1.

Conclusions: MIS MLTLIF can be performed in the elderly (70 years and older) with a major complication rate comparable to other MIS TLIF studies in the elderly4,7 and more favorable when compared to traditional open MLTLIF.2,3,8,9

Patient Care: Identify potential perioperative and postoperative complications in patients 70 years or older that may undergo multi-level lumbar interbody fusion. This will give the clinician more information when counselling potential surgical candidates

Learning Objectives: By the conclusion of this session, participants should be able to: 1) identify and describe perioperative and postoperative complications in the elderly undergoing multi-level transforaminal lumbar interbody fusion.

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