Journal de la colonne vertébrale

Perioperative Complication Rate using Minimally Invasive Lumbar Fusion Techniques in Elderly and Obese Patients with Degenerative Lumbar Disease

Abstract

Wolfgang Senker, Christian Meznik, Alexander Avian Mag and Andrea Berghold

Background: Minimally invasive spine surgery (MIS) is associated with less blood loss, faster recovery, and less perioperative morbidity while yielding similar results as those achieved with open procedures. The risk of periand postoperative complications in the elderly and obese patients is a much debated issue. MIS has been poorly investigated in aged and obese patients.

Objective: The aim of the present study is to establish whether MIS techniques are a safe and adequate tool in these patients.

Methods: A retrospective analysis of 33 patients aged 65 years or older, undergoing minimally invasive spinal fusion techniques, in order to identify the risk of peri- and postoperative morbidity in the obese. Obesity was classified according to the body mass index (BMI).

Results: Any harmful event was noted and included in the statistical analysis. The median blood loss and drainage in the postoperative monitoring period was 200 ml.  significant differences in blood loss were observed in relation to preoperative administration of NSAIDs. Patients using NSAIDs preoperatively had more frequent (p=0.055)  and greater (p= 0.014) blood loss. No difference in blood loss was noted with reference to age or BMI groups. No severe wound healing disorder was observed. We encountered 5 major complications, which consisted of one patient with a neurogenic deficit, one with a transient ischemic attack, one with cardiac ischemia, one with a  malpositioned rod, and one with an epidural hematoma. Minor complications included one patient with urinary tract infection, one with respiratory tract infection, and one with fever. No association was observed between complications and obesity.

Conclusion: This study confirms the low soft tissue damage resulting from minimally invasive surgery techniques, which is an important factor in elderly and obese patients. The smaller approach helps to minimize infections and wound healing disorders. Moreover, deeper regions of wounds are clearly visualized with the aid of tubular retractors.