2009 年 59 巻 1 号 p. 1-7
Study Design : Retrospective study. Objective : To report the clinical and radiological results of posterior lumbar interbody fusion (PLIF) using titanium intervertebral spacers in elderly patients over 70 years. Summary of Background Data : PLIF with intervertebral spacers has been introduced to treat degenerative lumbar disorders. However, in the elderly patients, it is concerned that there are several possible complications that can be associated with the use of interbody support in anterior column reconstruction under weak bone quality. There were few reports about the results of PLIF using titanium intervertebral spacers in elderly patients. Methods : Twenty-six patients with mean age of 73 years (range, 70-78) underwent one or two-level PLIF using titanium intervertebral blocks combined with posterior instrumentation, with minimum 2-year follow-up (average 49 months ; range, 25-88). Radiographic and clinical outcomes analysis was performed. Results : The sagittal alignment (regional lordosis) of the operative segments averaged 7.4° before surgery, 12.7° at discharge, 11.1° post-op 1-year, and 11.8° at the final follow-up. The percentage of posterior disc height was 14.1% before surgery, and was significantly improved after the surgery to 26.9% at discharge and 21.8% at the final follow-up. In 18 patients with spondylolisthesis, the percentage of slip averaged 18.9% before surgery, and was significantly improved after the surgery to 6.8% at discharge and maintained until the final follow-up. All patients had radiographic fusion at the follow-up. The average JOA score was 12.6 points before surgery, and increased significantly to 23.1 points at the final follow-up. Conclusion : Posterior lumbar interbody fusion using titanium spacers is valuable even in the elderly patients. The preservation of bony endplate of vertebral body, and the insertion of spacers as antero-lateraly as possible in the intervertebral space, are important for successful fusion.
