Clinical Results of Posterior Lumbar Interbody Fusion Using Titanium Intervertebral Spacers in Elderly Patients over 70 Years

摘要

Study Design : Retrospective study. Objective: To report the clinical and radiological results ofposterior lumbar interbody fusion (PLIF)using titanium intervertebral spacers in elderly patients over 70years. Summary of Background Data : PLIF with intervertebral spacers has been introduced to treatdegenerative lumbar disorders. However, in the elderly patients, it is concerned that there are severalpossible complications that can be associated with the use of interbody support in anterior columnreconstruction under weak bone quality. There were few reports about the results of PLIF usingtitanium intervertebral spacers in elderly patients. M ethods : Twenty-six patients with mean age of 73years(range,70-78)underwent one or two-level PLIF using titanium intervertebral blocks combined withposterior instrumentation,with minimum 2-year follow-up (average 49 months; range, 25-88). Radiographicand clinical outcomes analysis was performed. Results : The sagittal alignment (regionallordosis) of the operative segments averaged 7.4°before surgery, 12.7°at discharge, 11.1°post-op 1-year,and 11.8°at the final follow-up. The percentage of posterior disc height was 14.1％ before surgery,andwas significantly improved after the surgery to 26.9％ at discharge and 21.8％ at the final follow-up. In18 patients with spondylolisthesis, the percentage of slip averaged 18.9％ before surgery, and wassignificantly improved after the surgery to 6.8％ at discharge and maintained until the final follow-up.All patients had radiographic fusion at the follow-up. The average JOA score was 12.6 points beforesurgery,and increased significantly to 23.1 points at the final follow-up. Conclusion : Posterior lumbarinterbody fusion using titanium spacers is valuable even in the elderly patients. The preservation ofbony endplate of vertebral body, and the insertion of spacers as antero-lateraly as possible in theintervertebral space, are important for successful fusion.