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| KONG Chao,LU Shibao,SUN Xiangyao.Safety and efficacy of surgical treatment for aged patients with degenerative lumbar spinal stenosis[J].Chinese Journal of Spine and Spinal Cord,2018,(11):1004-1010，1019. |
| Safety and efficacy of surgical treatment for aged patients with degenerative lumbar spinal stenosis |
| Received:July 23, 2018 Revised:October 23, 2018 |
| English Keywords:Lumbar spinal stenosis Lumbar fusion Aged Complication |
| Fund:国家自然科学基金面上项目（81672201） |
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| English Abstract: |
| 【Abstract】 Objectives: To investigate the clinical outcomes and complications after surgical treatment for aged patients with degenerative lumbar spinal stenosis, and to evaluate the safety and efficacy. Methods: From December 2015 to June 2017, a total of 49 aged patients with degenerative lumbar spinal stenosis were treated with posterior lumbar fusion in our hospital, in them only 44 patients had complete data and a follow-up time over 6 months. Among the patients, 11 cases underwent one segment fusion, 21 cases in two segments, 7 cases in three segments and 5 cases in more than 3 segments. About comorbidities, ３４ patients(77.3%) were with hypertension, 13 patients(29.5%) had diabetes, 9 patients(20.5%) had coronary heart disease(3 patients underwent heart stent surgery, 1 patient underwent bypass surgery), 6 patients(13.6%) once had cerebral infarction without obvious sequela, 2 patients(4.5%) had chronic obstructive pulmonary disease and 2 patients(4.5%) had renal insufficiency. Patients were divided into two groups according to the segments fused: short segment group(<3 segments) and long segment group(≥3 segments). Demographic data, intraoperative blood loss, operation time, visual analoge score(VAS), functional Oswestry score(ODI) and complications were compared between the two groups. There were four levels of patients′ satisfaction degrees: very satisfied, satisfied, dissatisfied and very dissatisfied. Results: Forty-four(89.8%) patients underwent posterior lumbar fusion. The average operation time was 234.2±74.56min(100－411min), and the average intraoperative blood loss was 475.5±343.4ml(100-1400ml). Two patients had cerebrospinal fluid leakage, 5 had poor wound healing. The average follow-up time was 13.8±2.1 months(6-25 months). VAS score improved from 7.53±1.19 preoperatively to 2.38±1.58 at the final follow-up(P<0.001), and ODI score improved from (70.32±6.90)% preoperatively to (46.38±9.89)% at the final follow-up(P<0.001). Screw loosening occurred in 8 patients, cage retroposition in 2 patients, cage residence in 2 patients, revision surgery in 2 patients. At the final follow-up, ３０ patients were very satisfied, 6 patients were satisfied, 5 patients were dissatisfied and 3 patients were very dissatisfied, and the overall satisfaction rate was 81.8%. The two groups had no difference in age and BMI, with more female patients, longer operation time and more blood loss in long segment group. The improvement rates of VAS score and ODI score in the two groups were not significantly different. Compared with those in long segment group, the reoperation rate, screw loosening rate and cage retroposition rate in short segment were lower. Conclusions: Aged patients with degenerative lumbar spinal stenosis always have many comorbidities and more perioperative complications related to fusion segments. However, with proper control of internal medicine diseases and cautious surgical procedures, the operation can be safe, and patients′ clinical and function score can be significantly improved. |
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