Assessing Morbidity and Outcomes of Posterior Lumbar Fusion in Elderly Patients: A Systematic Review and Meta-Analysis

TL;DR

This study reviews the risks and benefits of spinal surgery in elderly patients, finding that while there are some risks, the procedure leads to significant improvements in function and pain.

Contribution

The study provides a comprehensive meta-analysis of outcomes for posterior lumbar fusion in elderly patients, emphasizing functional improvements.

Findings

The pooled mortality rate was 0.7% with a mean operative duration of 181.6 minutes and average blood loss of 337.8 ml.

Significant postoperative improvements were observed in disability and pain scores, with increased JOA scores by 9.9 points.

Complication rates included dural tears (4.3%), neurological deficits (2.2%), metalwork failure (7.06%), and wound dehiscence (3.29%).

Abstract

This review aims to evaluate the morbidity, mortality, and functional outcomes associated with instrumented posterior lumbar arthrodesis in elderly patients aged 65 years and above. A systematic review and meta-analysis adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted using PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online), Cochrane, Embase, Emcare, CINAHL (Cumulated Index to Nursing and Allied Health Literature), and the international prospective register of systematic reviews (PROSPERO) databases. Relevant studies were identified based on inclusion criteria, with data extraction focusing on mortality rates, operative duration, blood loss, length of hospital stay, complication rates, and clinical and functional outcomes. Functional assessments included the Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, and the Visual Analogue Scale (VAS) for pain intensity. Out of 6,241 studies, 45 met the inclusion criteria. The pooled mortality rate was 0.7% (95%CI: 0.2-1.3%), with a mean operative duration of 181.6 minutes (95%CI: 138.8-224.5 minutes) and an average blood loss of 337.8 ml. Complication rates included dural tears (4.3%), neurological deficits (2.2%), metalwork failure (7.06%), and wound dehiscence (3.29%). Significant postoperative functional improvements were observed, with reductions in ODI by 3.47 points, leg pain intensity by 4.29 points on the VAS, back pain intensity by 4.95 points on the VAS, and an increase in JOA scores by 9.9 points. Despite concerns regarding morbidity and mortality, this meta-analysis highlights that instrumented posterior lumbar arthrodesis in elderly patients is associated with considerable improvements in clinical and functional outcomes, supporting its role in the management of degenerative spinal conditions in this population.

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