Our Summary

The research paper focuses on the clinical outcomes of a minimally invasive spine surgery technique called Lateral Lumbar Interbody Fusion (LLIF) on patients over the age of 70. The LLIF procedure is seen as a way to treat various spinal conditions while minimizing complications that can be common in elderly patients due to their age and other health issues.

The study used a database to gather information on patients aged over 70 who had undergone LLIF. They excluded patients who had other types of fusion surgeries. They analyzed the patients’ disability index scores before and after the operation to see how effective the treatment was. They also looked at the patients’ bone density scores to see if there was a relationship between bone density and graft subsidence, a potential complication where the bone graft sinks into the vertebral body.

The study involved 55 patients, with an average age of 74. Some patients had multiple health issues. The typical blood loss during the surgery was quite low, and the average hospital stay was two days. Neither of these factors was significantly affected by the patient’s age or the complexity of the operation. One patient died during surgery due to cardiac arrest, and one experienced a temporary nerve injury. Five patients had graft subsidence and needed further surgery. The researchers found a link between low bone density scores and a higher risk of graft subsidence.

The disability index scores of the patients improved significantly one year after the operation. The researchers concluded that the LLIF procedure can be safely and effectively performed on elderly patients, although an evaluation of the patient’s bone density should be done before surgery to minimize the risk of complications. The study suggests that age alone should not be a reason to prevent elderly patients from undergoing this type of surgery.

FAQs

  1. What is the Lateral Lumbar Interbody Fusion (LLIF) procedure and why is it beneficial for patients over the age of 70?
  2. What were the main findings of the study regarding the effectiveness and safety of the LLIF procedure in elderly patients?
  3. Why is the evaluation of a patient’s bone density important before undergoing the LLIF procedure?

Doctor’s Tip

A doctor might tell a patient considering lumbar fusion surgery to ensure they have their bone density evaluated before the procedure to minimize the risk of complications such as graft subsidence. Additionally, they may advise the patient that age alone should not be a reason to prevent them from undergoing the surgery, as the study showed positive outcomes for elderly patients who underwent the LLIF procedure.

Suitable For

Typically, patients who are recommended lumbar fusion surgery are those who have:

  1. Severe back pain that has not improved with conservative treatments such as physical therapy, medication, and injections.
  2. Nerve compression or spinal instability due to conditions such as degenerative disc disease, spondylolisthesis, spinal stenosis, or spinal fractures.
  3. Failed previous spine surgery.
  4. Significant loss of disc height or spinal alignment.
  5. Patients who are otherwise healthy enough to undergo surgery and have a good chance of successful outcomes.

It is important for patients to discuss their symptoms, medical history, and treatment options with a spine specialist to determine if lumbar fusion surgery is the best course of action for their specific condition.

Timeline

In summary, before lumbar fusion, a patient may experience symptoms such as back pain, leg pain, numbness, and weakness. They may undergo various conservative treatments such as physical therapy, medications, and injections to manage their symptoms. If these treatments are not effective, they may be recommended for surgery.

After lumbar fusion, patients typically experience immediate relief from nerve compression symptoms but may have to undergo a period of rehabilitation and physical therapy to regain strength and mobility. Over time, patients can expect to see improvements in their pain levels and functionality, with the goal of returning to their normal activities and quality of life.

Overall, the timeline for a patient before and after lumbar fusion can vary depending on individual factors such as their overall health, the extent of their spinal condition, and the specific surgical technique used. It is important for patients to work closely with their healthcare team to understand what to expect throughout the entire process and to follow their post-operative care instructions to ensure the best possible outcome.

What to Ask Your Doctor

Questions a patient should ask their doctor about lumbar fusion based on this research paper may include:

  1. Is Lateral Lumbar Interbody Fusion (LLIF) a suitable option for me, considering my age and health conditions?
  2. What are the potential complications of LLIF surgery, and how common are they in elderly patients?
  3. Will my bone density be evaluated before the surgery to assess the risk of graft subsidence?
  4. How long is the typical hospital stay after LLIF surgery for elderly patients?
  5. What is the expected recovery process and timeline for elderly patients undergoing LLIF surgery?
  6. Are there any specific precautions or considerations for elderly patients during the recovery period?
  7. What are the expected outcomes in terms of pain relief and improvement in disability index scores for elderly patients after LLIF surgery?
  8. How will my overall health and age affect the success of the surgery and the likelihood of complications?
  9. Are there any alternative treatment options that may be more suitable for me based on my age and health status?
  10. How many LLIF procedures have you performed on elderly patients, and what is your success rate in this age group?

Reference

Authors: Agarwal N, Faramand A, Alan N, Tempel ZJ, Hamilton DK, Okonkwo DO, Kanter AS. Journal: J Neurosurg Spine. 2018 Nov 1;29(5):525-529. doi: 10.3171/2018.3.SPINE171147. Epub 2018 Jul 27. PMID: 30052150