Surgical Complications of Transforaminal Lumbar Interbody Fusion in Elderly Patients

Chung, Sung Kyun; Kim, Kyoung Tae; Kim, Young Baeg

Abstract

OBJECTIVE
The purpose of this study was to analyze the surgical complications of transforaminal lumbar interbody fusion (TLIF) with pedicle screw fixation (PSF) in elderly patients.
METHODS
A retrospective analysis of 210 patients who underwent TLIF & PSF was performed via the paraspinal transmuscular route from January 2004 to October 2007. Forty-one patients aged 65 years or more at the time of operation (Group 1) and 169 patients under the age of 65 years (Group 2) were involved in this study. Intraoperative and postoperative complications were investigated.
RESULTS
The series included 94 men and 116 women. The mean age of the patients at the time of operation was 70.9+/-5.4 years in Group 1 and 49.3+/-9.5 years in Group 2. The minimum follow-up period was 24 months, and the mean follow-up period was 40.7+/-11.5 months. In Group 1, intraoperative complication occurred in 3 patients (7.3%; dural tear), and postoperative complications were postoperative delirium(5 patients, 12.2%), acute myocardial infarction (2 patient, 4.9%), transient ischemic attack (2 patient, 4.9%), spondylodiscitis (3 patients, 7.3%), adjacent segment disease (7 patients, 17.1%) and pedicle screw loosening (4 patients, 9.8%). In Group 2, intraoperative complication occurred in 3 patients (1.8%; dural tear), and postoperative complications were postoperative delirium(3 patients, 1.8%), acute myocardial infarction (1 patient, 0.6%), transient ischemic attack (1 patient, 0.6%), spondylodiscitis (4 patients, 2.4%), adjacent segment disease (4 patients, 2.4%), pedicle screw fracture (5 patients, 3.0%) and pedicle screw loosening (2 patients, 1.2%). Among various complications, dural tear, postoperative delirium, spondylodiscitis, adjacent segment disease and pedicle screw loosening were statistically more frequent in the elderly patients.
CONCLUSION
As the TLIF and PSF procedures yielded a relatively high complication rate in elderly patients, delicate intraoperative and postoperative care is needed.