Journal of Korean Society of Geriatric Neurosurgery 2015;11(2):215-220.
Published online September 30, 2015.
Perioperative Complications and Radiologic Changes of Cervical Anterior Discectomy and Fusion (ACDF) with Stand-Alone Cage in Geriatric Patients
Bang Ryu , Sung-Bum Kim , Bong-Jin Park , Tae-Sung Kim , Young-Jin Lim
Department of Neurosurgery, Kyung Hee University School of Medicine, Seoul, Korea
With increase of aging populations, incidence of cervical anterior discectomy and fusion (ACDF) for geriatric patients have been increasing, especially patients of age over than 65. The goal of our study is to find out perioperative complications and subsidence rate associated with ACDF using stand-alone cage in elderly, and consider its preventions.
In a retrospective study, 64 patients (34 males and 30 females) who underwent anterior interbody fusion with a stand-alone cage for 5 years were evaluated. The surgical level, hospital stay, postoperative day, comorbidities, complications, and clinical symptoms of the 2 groups (65-70 years old and over 71 years) were analyzed. Operative reports, hospital and outpatient clinic charts, and radiographic studies were reviewed.
In group A (65-70 years old), the mean number of postoperative days and the mean hospital stay were 8.21 and 10.6 days, respectively. For group A, the operative indications were radiculopathy (n=24) and myelopathy (n=4). Cage subsidence occurred in 12 patients in group A. Regarding surgical levels, the most common was one level (n=20), followed by three levels (n=4) and two levels (n=2). In group B (over 71 years old), the mean number of postoperative days and the mean hospital stay were 11.78 and 16.6 days, respectively. Subsidence occurred in 30 patients. Operative indications included radiculopathy (n=14) and myelopathy (n=22). Twenty patients had one surgical level. Two levels and three levels were required in 12 and 4 patients, respectively. In our study, there was only 1 case of post-operative hematoma. Mean follow-up period was 11.3 months.
We hypothesized that longer hospital stays and more postoperative days in group B might be associated with the need for more in-depth management of comorbidities. Additionally, the higher cage subsidence rate might be closely associated with the severity of osteoporosis in this population of patients over age 71. Due to these factors, we recommend special planning when performing cervical ACDF in geriatric patients over the age of 71.
Key Words: Cervical spineㆍDiscectomyㆍComplicationㆍGeriatrics

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