Retrospective observatory comparison of lumbar interbody fusion with pedicle screw fixation and cortical screw fixation for clinical outcome, including sagittal balance, in geriatric patients over 80 years old: a single-center, one-decade experience

Abstract

Abstract Background We aimed to retrospectively analyze the clinical and surgical outcomes following posterior lumbar interbody fusion plus pedicle screw fixation compared to midline lumbar fusion in patients aged ≥ 80 years with degenerative lumbar spine disease. Methods The study group comprised 68 patients aged ≥ 80 who underwent degenerative lumbar spinal surgery at our spine center between January 2011 and December 2020. Among them, 24 underwent posterior lumbar interbody fusion plus pedicle screw fixation, and the remaining 44 underwent midline lumbar fusion. Results No significant intergroup differences were found in age, sex ratio, follow-up duration, or surgical level. The Visual Analog Scale for lower back pain was significantly different between the two groups at 7 days after surgery (P = 0.049). The Oswestry Disability Index was significantly different between the two groups at 7 days after surgery (P = 0.05). The estimated blood loss and operative time differed significantly (P < 0.05). There was a statistically significant difference in the postoperative morbidities between the groups (P = 0.049). Conclusions Although the clinical outcomes were not significantly different between the two groups, the perioperative morbidity was better in the midline lumbar fusion group. Therefore, we conclude that midline lumbar fusion is not inferior to posterior lumbar interbody fusion plus pedicle screw fixation if there is a need for fusion in elderly patients over octogenarian. Trial registration The Institutional Review Board of National Health Insurance Service Ilsan Hospital approved this study (2022-01-027), and the requirement of informed consent was waived due to the study's retrospective nature.