Patel Jwalant Y, Kundnani Vishal G, Chawada Bansari
Mumbai Institute of Spine Surgery, Bombay Hospital and Medical Research Centre, Mumbai, India.
Department of Preventive and Social Medicine, Medical College Baroda, Vadodara, India.
Asian Spine J. 2021 Aug;15(4):447-454. doi: 10.31616/asj.2020.0084. Epub 2020 Oct 19.
Retrospective cohort.
This study's primary objective was to compare the clinico-radiological outcomes and incidence of perioperative complications of transforaminal lumbar interbody fusion (TLIF) at lower lumbar levels for elderly and younger patients. The secondary objective was to evaluate the effect of age on clinical outcomes and patient satisfaction in the two groups.
The lumbar interbody fusion surgery in elder age has been reported to produce a higher complication rate and suboptimal results. Literature evaluating efficacy and safety of TLIF in elderly population is scanty. The effect of age on clinical outcome and the overall patient satisfaction after TLIF has been understudied.
This retrospective study was conducted from 2011 to 2017 with 121 patients, who underwent TLIF and were divided into two cohorts based on age (group A, >65 years and group B, <65 years). Perioperative clinical/radiological parameters, postoperative complications, and satisfactory outcomes were evaluated in both groups. A statistical analysis between two matched groups was performed with logistic regression analysis and Student t-test.
The mean age was 73.8±4.5 years in group A and 47.3±12.7 years in group B. There was no statistical difference in surgical time (p=0.15), mobilization, or hospital stay (p=0.15) between the two groups. There were no statistically significant differences noted in the Oswestry Disability Index, Visual Analog Scale, or Wang's outcome score between the two groups at final follow-up. Postoperative complications not affecting outcome were common in the elderly group, but there was no statistically significant difference noted among neurological or cardiopulmonary events between the two groups.
In judiciously selected patients with proper preoperative risk assessment and optimized medical co-morbidities, TLIF surgery can have successful results, in terms of clinical outcome and satisfaction, in the elderly. Older age should not be a contraindication for TLIF in patients with degenerative lumbar disease.
回顾性队列研究。
本研究的主要目的是比较老年和年轻患者在下腰椎节段经椎间孔腰椎椎间融合术（TLIF）的临床放射学结果及围手术期并发症发生率。次要目的是评估年龄对两组临床结果和患者满意度的影响。
据报道，老年患者的腰椎椎间融合手术并发症发生率较高且效果欠佳。评估TLIF在老年人群中疗效和安全性的文献较少。年龄对TLIF术后临床结果和患者总体满意度的影响尚未得到充分研究。
本回顾性研究在2011年至2017年期间对121例行TLIF手术的患者进行，根据年龄分为两组（A组，>65岁；B组，<65岁）。评估两组的围手术期临床/放射学参数、术后并发症及满意结果。对两个匹配组进行逻辑回归分析和学生t检验的统计学分析。
A组平均年龄为73.8±4.5岁，B组为47.3±12.7岁。两组间手术时间（p = 0.15）、活动能力或住院时间（p = 0.15）无统计学差异。末次随访时，两组间Oswestry功能障碍指数、视觉模拟评分或王式疗效评分无统计学显著差异。老年组中不影响结果的术后并发症常见，但两组间神经或心肺事件无统计学显著差异。
对于经过审慎选择、术前风险评估适当且合并症得到优化治疗的患者，TLIF手术在临床结果和满意度方面对老年人可取得成功效果。对于患有退行性腰椎疾病的患者，高龄不应成为TLIF的禁忌证。
