高齢者不安定性腰椎に対する腰椎椎体間固定術の治療成績と問題点

抄録

  Background and Purpose : Surgical indication of lumbar interbody fusion (LIF) in elderly patients remains controversial because of potential risks such as inferior bone quality and a higher rate of postoperative complications. However, clinical efficacy and operative risk of LIF in elderly patients have not been estimated sufficiently. The aim of this study was to investigate clinical effect and safety of LIF for lumbar degenerative disease with segmental instability in patients who were seventy years of age or older.

  Methods : The authors retrospectively reviewed the results of 37 patients with mean age 74.8 years (range 70-86) who underwent one or two-level LIF augmented with pedicle screw fixation system. The preoperative diagnosis included degenerative or isthmic spondylolisthesis with instability. Clinical outcomes were assessed by the JOA (Japanese Orthopaedic Association) score, VAS (visual analog scale), and patient's satisfaction. Radiological fusion rate was also investigated. Clinical and radiological results were compared with those of younger patients and adverse factor related to poor clinical results were also analyzed.

  Results : Clinical outcome measures were significantly improved after operation in elderly patients, but improvement rates were statistically lower than those of younger patients. Fusion rate was similar in both groups. Overall postopetrative complications were increased in aged patients, although the prevalence of complications directly related to surgery was not significant. Postoperative complications not related surgery and reoperation were affecting factors resulting in poor results.

  Conclusion : LIF is thought to be an accepted method of achieving lumbar fusion with high radiographic fusion success even in elderly patients, although clinical benefits were limited compared with those of younger patients. Postoperative morbidity was mainly related to general or non-lumbar site complications.