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I'm debating about having a spinal fusion for a broken down disc. At my age (72), I have learned to live with a great deal of pain. The surgery is supposed to help but there could be worse problems after. What can you tell me that might help me make this decision?
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Back pain from degenerative disc disease can be very disabling for older adults. In a recent study, orthopedic surgeons showed how a simple spinal fusion can make a big difference in patients 65 years old and older.
The surgeons fused a single spinal level of 224 patients and then followed them for two years to see the results. The group was divided into two groups by age. Anyone younger than 65 years was in the first group. Patients 65 years old and older were in the second group.
The operation performed was a single-level posterolateral lumbar arthrodesis with iliac crest bone graft. Posterolateral refers to the direction (back and side) that the fusion was done. Iliac crest bone graft comes from the top of the pelvic bone. Instrumentation (rod and screws) were used to hold the segment stable until bone filled in around the bone graft. The spinal level fused was slightly different between the two groups. The older patients' fusion was in the L345 region. The younger patients were more likely to have a fusion at the L5-S1 level.
Everyone in both groups had significant improvements in their test scores. But the older group demonstrated a larger change in scores indicating greater improvement compared to the younger patients. Complications in the early postoperative period (first 30 days) were higher among the older adults. Half of the older group had an adverse event after surgery. This was compared to one-third of the younger group. Most of the problems were minor but some patients had a heart attack, blood clot, or infection.
The authors concluded that older adults having a single level spinal fusion for degenerative disc disease can have a marked decrease in disability and improved health-related quality of life. The substantial benefit demonstrated in this study supports the use of this procedure for adults 65 years of age and older. The procedure is not without some potential complications, but overall it is safe and effective. Improvement seemed to occur even in those patients who had some type of problem after surgery.
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