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J Neurol Surg A Cent Eur Neurosurg 2023; 84(06): 548-557
DOI: 10.1055/s-0042-1757164
Original Article

Anterior Lumbar Interbody Fusion in Elderly Patients: Peri- and Postoperative Complications and Clinical Outcome

Christopher M. Jesse 
1   Department of Neurosurgery, Inselspital, University of Bern, Bern University Hospital, Bern, Switzerland
,
Lea Mayer
1   Department of Neurosurgery, Inselspital, University of Bern, Bern University Hospital, Bern, Switzerland
,
Levin Häni
1   Department of Neurosurgery, Inselspital, University of Bern, Bern University Hospital, Bern, Switzerland
,
Johannes Goldberg
1   Department of Neurosurgery, Inselspital, University of Bern, Bern University Hospital, Bern, Switzerland
,
Andreas Raabe
1   Department of Neurosurgery, Inselspital, University of Bern, Bern University Hospital, Bern, Switzerland
,
Othmar Schwarzenbach   *
2   dasRueckenzentrum AG, Thun, Switzerland
,
Ralph T. Schär    *
1   Department of Neurosurgery, Inselspital, University of Bern, Bern University Hospital, Bern, Switzerland
› Author Affiliations Funding The Department of Neurosurgery, University Hospital Bern, University of Bern, funded the study. No external funding was received.
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Abstract

Background Anterior lumbar interbody fusion (ALIF) is an effective surgical technique for treating various lumbar pathologies, but its use in elderly patients is controversial. Data concerning complications and effectiveness are sparse. We investigated peri- and postoperative complications, radiographic parameters, and clinical outcome in elderly patients.

Methods Patients ≥65 years who underwent ALIF between January 2008 and August 2020 were included in the study. All surgeries were performed through a retroperitoneal approach. Clinical and surgical data as well as radiologic parameters were collected prospectively and analyzed retrospectively.

Results A total of 39 patients were included; the mean age was 72.6 (±6.3) years (range: 65–90 years); and the mean American Society of Anesthesiologists (ASA) risk classification was 2.3 (±0.6). A laceration of the left common iliac vein was the only major complication recorded (2.6%). Minor complications occurred in 20.5% of patients. Fusion rate was 90.9%. Reoperation rate at the index level was 12.8 and 7.7% in adjacent segments. The multidimensional Core Outcome Measures Index (COMI) improved from 7.4 (±1.4) to 3.9 (±2.7) after 1 year and to 3.3 (±2.6) after 2 years. Oswestry disability index (ODI) improved from 41.2 (±13.7) to 20.9 (±14.9) after 1 year and to 21.5 (±18.8) after 2 years. Improvements of at least the minimal clinically important change score of 2.2 and 12.9 points in the ODI and COMI after 2 years were noted in 75 and 56.3% of the patients, respectively.

Conclusion With careful patient selection, ALIF is safe and effective in elderly patients.

Keywords

ALIF - anterior lumbar interbody fusion - lumbar fusion - spine surgery in elderly

Author Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by C.M.J., L.M., and O.S. The first draft of the manuscript was written by LM and all authors commented on previous versions of the manuscript. C.M.J. and R.T.S. supervised the whole project. All authors read and approved the final manuscript.


Availability of Data and Material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.


Ethics Approval

Approval from the local ethics committee of the canton of Bern, Switzerland, for this study (2020–02659) was obtained.


Consent for Publication

All authors revised the manuscript and approved the version to be published.


* Contributed equally.




Publication History

Received: 06 December 2021

Accepted: 28 June 2022

Article published online:
16 May 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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