Bouloussa Houssam, Alzakri Abdulmajeed, Ghailane Soufiane, Vergari Claudio, Mazas Simon, Vital Jean-Marc, Coudert Pierre, Gille Olivier
Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France.
Orthopaedic Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Int Orthop. 2017 Oct;41(10):2091-2096. doi: 10.1007/s00264-017-3555-6. Epub 2017 Jul 26.
The purpose of this study was to evaluate the safety and tolerance of lumbar spine surgery in patients over 85.
Patients over 85 years of age with LSS who underwent decompression surgery with or without fusion between February 2011 and July 2014 were included. Comorbidities, autonomy (Activities of Daily Life and Braden scales), surgical parameters and complications (Clavien-Dindo classification) were collected. A telephone survey was performed to assess survival and patients' satisfaction at last follow-up.
Mean follow-up was 27.4 ± 7.6 months (range, 18-65). Mean age was 87.5 ± 2.7 years (range, 85-97). Mean ADLs and Braden scores were, respectively, 4.3 ± 1.2 and 20.2 ± 1.4. Fifteen patients had associated spondylolisthesis. Nineteen minor complications (grade I and II, 38.7%), five moderate complications (grade III, 10.2%) and six major complications (grade IV and V, 12.2%) occurred. The perioperative mortality rate was 0.02%. At last follow-up, 41 patients were very satisfied (83.7%), five patients were satisfied (10.2%) and three patients were not satisfied (6.1%). Fusion did not affect the incidence of complications (p = 0.3) nor the average number of complications per patient (p = 0.2).
Advanced age should not be a contraindication to lumbar spine surgery provided careful preoperative selection is performed. This study reported a high satisfaction rate and a low mortality rate at the price of a high number of complications, most of which being minor.
本研究旨在评估85岁以上患者腰椎手术的安全性和耐受性。
纳入2011年2月至2014年7月期间接受减压手术（有或无融合）的85岁以上腰椎管狭窄症患者。收集合并症、自主性（日常生活活动和布拉德评分）、手术参数和并发症（Clavien-Dindo分类）。进行电话调查以评估末次随访时的生存率和患者满意度。
平均随访时间为27.4±7.6个月（范围18 - 65个月）。平均年龄为87.5±2.7岁（范围85 - 97岁）。平均日常生活活动评分和布拉德评分分别为4.3±1.2和20.2±1.4。15例患者合并腰椎滑脱。发生19例轻度并发症（I级和II级，38.7%）、5例中度并发症（III级，10.2%）和6例重度并发症（IV级和V级，12.2%）。围手术期死亡率为0.02%。末次随访时，41例患者非常满意（83.7%），5例患者满意（10.2%），3例患者不满意（6.1%）。融合术不影响并发症发生率（p = 0.3），也不影响每位患者的平均并发症数量（p = 0.2）。
如果进行仔细的术前筛选，高龄不应成为腰椎手术的禁忌证。本研究报告了较高的满意度和较低的死亡率，但代价是并发症数量较多，其中大多数为轻度并发症。
