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  • Perioperative and Postoperative Complications of Multi-level Minimally Invasive Transforaminal Lumbar Interbody Fusion for Spinal Degeneration in the Elderly

    Final Number:

    Chad F Claus D.O.; Evan Joseph Lytle DO; Doris Tong MD; Matthew Bahoura BA; Jake Jasinski D.O.; Ascher B Kaufmann BS; Boyd Richards DO; Teck-Mun Soo MD

    Study Design:

    Subject Category:

    Meeting: Section on Disorders of the Spine and Peripheral Nerves Spine Summit 2019

    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.

    References: 1. Deyo RA, Cherkin DC, Loeser JD, et al. Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure. J Bone Joint Surg Am 1992;74:536–43. 2. Carreon LY, Puno RM, Dimar JR, et al. Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am 2003;85-A:2089–92. 3. Fujita T, Kostuik JP, Huckell CB, et al. Complications of spinal fusion in adult patients more than 60 years of age. Orthop Clin North Am 1998;29:669–78. 4. Karikari IO, Grossi PM, Nimjee SM, et al. Minimally invasive lumbar interbody fusion in patients older than 70 years of age: analysis of peri- and postoperative complications. Neurosurgery 2011;68:897–902; discussion 902. 5. Lee DY, Jung T-G, Lee S-H. Single-level instrumented mini-open transforaminal lumbar interbody fusion in elderly patients. J Neurosurg Spine 2008;9:137–44. 6. Rodgers WB, Gerber EJ, Rodgers JA. Lumbar fusion in octogenarians: the promise of minimally invasive surgery. Spine 2010;35:S355-360. 7. Lee P, Fessler RG. Perioperative and postoperative complications of single-level minimally invasive transforaminal lumbar interbody fusion in elderly adults. J Clin Neurosci Off J Neurosurg Soc Australas 2012;19:111–4. 8. Deyo RA, Ciol MA, Cherkin DC, et al. Lumbar spinal fusion. A cohort study of complications, reoperations, and resource use in the Medicare population. Spine 1993;18:1463–70. 9. Raffo CS, Lauerman WC. Predicting morbidity and mortality of lumbar spine arthrodesis in patients in their ninth decade. Spine 2006;31:99–103.

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