Mother is an octogenarian and proud of it. After a lifetime of active service as a school teacher, she's retired but suffering from severe low back pain. The surgeon has suggested surgery to fuse two spinal levels. They tell us everything is less invasive now and that she will recover quickly. But we're still quite worried that she could lose more than she gains from something like this. What can you tell us about these fusion operations?
More and more older adults are passing that 80 year old mark that puts them in the category as an octogenarian. Degenerative disc disease and other degenerative conditions of the spine are putting a hamper on even the most active seniors. But the good news is they don't have to suffer.
Studies show that spinal fusion in the older crowd can be done safely and effectively. With the newer technologies and minimally invasive surgeries, patients are in the hospital fewer days. They are more likely to go directly home rather than to a skilled nursing facility. With less blood loss, complications are down (including fewer deaths).
To help illustrate the advantages of minimally invasive lumbar fusion, a recent study from Spine Midwest out of Jefferson, Missouri compared patients 80 and older having lumbar spinal fusions. Half the group had an open incision procedure. The other half was operated on using a minimally invasive approach. Minimally invasive means a smaller incision is made. Using a special retractor system, the muscles and soft tissues can be pulled aside instead of cutting away from the spine.
The hospital stay was four days shorter for the minimally invasive group. Only three of the patients who had the minimally invasive approach were sent to skilled nursing facilities. Those who had the open posterior lumbar interbody fusion (PLIF) were all discharged to the skilled nursing facility for further care and rehab. They were unable to return home.
The PLIF group had more serious complications such as infection, poor wound healing, and bone fracture. Even the number of deaths in the first six months after surgery was higher in the open PLIF group (six deaths in the PLIF group compared with only one in the minimally invasive group). Infection and blood loss were the reasons most patients died.
The surgeons also found that with the minimally invasive extreme lateral approach to fusion, they could insert a larger implant into the disc space compared with the posterior approach. A larger implant helps maintain the proper disc height between two vertebrae and improves spinal alignment. And with larger implants and greater stability, they could reduce what might have been a multi-level fusion down to only one-level.
Their results showed once again that surgical treatment for older adults suffering from severe, chronic low back doesn't have to be withheld because of their age. Careful selection of patients and use of minimally invasive techniques can make the difference between a life of pain and suffering and maintaining an active, pain free quality of life. That's important if you are 80+ years old but still have many more good years to live!