PEDICLE SCREW FIXATION FOR ARTHRODESIS OF THE LUMBOSACRAL SPINE IN THE ELDERLY - AN OUTCOME STUDY

Study Design. An analysis of the outcome and effectiveness of instrume nted arthrodesis of the lumbosacral spine in elderly patients conducte d using a review of records, assessment of fusion via plain radiograph s, and a two-part questionnaire. Objective. To ascertain the outcome a nd efficacy of instrumented arthrodesis of the lumbosacral spine in pa tients 60 years of age and older. Background Data. From 1987 to 1991, 38 patients of at least 60 years of age underwent instrumented arthrod esis of the lumbosacral spine using the Wiltse or Selby pedicle screw fixation system (Advanced Spine Fixation Systems, Inc., Irvine, CA). P atients were considered for surgery only after attempts at conservativ e management, including physical therapy, medication, injection blocks , and home exercises, had proven unsuccessful. Methods. Follow-up exam inations were performed 3 months, 6 months, 1 year, and 2 years after surgery. Fusion was assessed using plain radiographs, including flexio n-extension films. Inpatient and outpatient records were reviewed, and a two-part questionnaire was used to establish the effect of surgery on function and lifestyle. Thirty patients responded to the questionna ire. Follow-up observation of the patients ranged from 25 to 56 months . The mean age was 73.8 years (range, 60-90 years). Results. The mean co-morbidity was 1.7. Based on the authors' method of evaluation of fu sion, the fusion rate was 92%. Fifty-seven percent of the patients rep orted excellent or good results, 26% reported fair results, and 17% re ported poor results. Functional gains of 50% or more were reported by 71% of the respondents. Female patients had significantly more complic ations than male patients, but reported comparable outcomes. Conclusio n. Despite the increase in age, co-morbidity, and associated risk of p erioperative complications inherent in this population, an outcome com parable with that of younger patients is reported.