Spinal Fusion for Stenosis in Older Adults with Osteoporosis
In this study, 39 patients over the age of 65 were treated surgically for severe lumbar stenosis. Spinal stenosis describes a clinical syndrome of buttock or leg pain with or without back pain. The opening for the spinal cord and spinal nerves narrows with age. Pressure on the nerve tissue can cause this pain, and in some cases, numbness, tingling, and weakness.
With older adults living longer, in better health, and more active, effective treatment for this problem is needed. Decompressive surgery to remove the bone from around the nerve tissue is often needed. The spine is then stabilized with a fusion. Results of this type of fusion was the focus of this study.
Titanium rods and screws were used for the fusion. This type of allow is less stiff and allows some give. A less rigid rod is needed when the bone is osteoporotic (brittle). Poor bone density makes it difficult to attach fixation hardware. Stiffless rods are a good solution for this problem.
X-rays and bone density tests were done on each patient before and after the operation. About one-fourth of the group had a one-level fusion. Half the group had two levels fused. The rest were three or four-level fusions. Everyone was followed for at least two years.
There were no major problems reported after fusion for the entire group. No reoperation or adjustment to the hardware was needed. Fusion was complete in 35 of the 39 patients. Broken rods and screws occurred in a few cases but did not cause any symptoms. The spines remained stable in those cases.
The authors concluded that less rigid fixation can be used successfully when the patient has poor bone quality. This means that patients with severe lumbar spinal stenosis who also have osteoporosis can be treated surgically.
The use of small diameter Titanium rods with large thread is advised. This eliminates the need for reinforced anchoring to the bone. Complete correction of spinal deformity caused by vertebral rotation or slippage is not needed. Further study using this less rigid fixation is still needed.
Remi Cavagna, MD, et al. Lumbar Decompression and Fusion in Elderly Osteoporotic Patients: A Prospective Study Using Less Rigid Titanium Rod Fixation. In Journal of Spinal Disorders & Techniques. April 2008. Vol. 21. No. 2. Pp. 86-91.