Instrumentation-Related Complications of Multilevel Fusions for Adult Spinal Deformity Patients Over Age 65: Surgical Considerations and Treatment Options in Patients With Poor Bone Quality

Abstract

In Brief Study Design. Retrospective follow-up of patients over the age of 65 with a minimum of five-level fusions. Objective. To determine the effect on outcomes of long constructs in patients with poor bone stock, and to review surgical techniques used in patients with poor bone stock. Summary of Background Data. Scoliotic deformities in patients with poor bone stock require alterations in both the surgical technique and preoperative planning. To our knowledge, complications of long constructs in poor bone stock have not been specifically reported. Methods. Patients over the age of 65 that underwent a minimum of five-level fusion over a 5-year period were reviewed. We reviewed both operative reports and clinic notes and recorded both early and late complications. Results. Early complications included pedicle fractures and compression fractures with an overall rate of 13%. Late complications included pseudarthroses with instrumentation failure, adjacent level disc degeneration with herniation, compression fractures, and progressive kyphosis. Progressive junctional kyphosis occurred in 26% of patients. Conclusions. Spinal stabilization surgery in patients with poor bone stock is associated with high complication rates. Complications such as progressive kyphosis adjacent to the fusion are difficult to address with instrumentation alone. This is a retrospect review of patients over 65 years old undergoing longer spinal fixation constructs for spinal deformities. This review highlights the modes of instrumentation failures in this older group of patients. Additionally, the surgical techniques used for spinal deformity patients with poor bone quality or osteoporosis are reviewed and discussed.