ABSTRACT

Background Data:

The patients with degenerative spondylolisthesis are candidates for surgery who have persistent and recurrent back and leg pain or neurogenic claudication, with significant reduction of quality of life and progressive neurologic deficit despite a conservative treatment which takes at least 3 months. It has been reported that better longterm functional results can be achieved with instrumented fusion in the surgical treatment but it can cause more complications.

Objective:

To determine the incidence and risk factors of complications encountered in patients with degenerative lumbar spondylolisthesis who has instrumented posterolateral fusion.

Material and Methods:

Between 2006 and 2009, instrumented posterolateral fusion and posterior decompression were applied to 28 patients (22 females, 6 males; mean age 62,7, range 54-68) with degenerative lumbar spondylolisthesis who had persistent and recurrent back and leg pain with neurogenic claudication despite a conservative treatment which took at least 3 months. The average follow-up was 24,2 months (range 14-37 months). The number of co-morbidities, the age of patients, the surgical time, estimated blood loss, and the number of fused segments were recorded separately. The relation with above-mentioned parameters and early (<3 months) and late (>3months) period complications was evaluated.

Results:

Severe co-morbidities such as diabetus mellitus, hypertension, heart disease, osteoporosis, gastro-intestinal disease and depression were observed in 22 (78 %) patients. Mean surgical time was 172.7 ± 26.8 minutes and mean estimated blood loss was 862.5 ± 269 ml. The mean number of fused segment was 1.9 ± 0.7. Early period complications were seen in 10 (30 %) patients and late period complications were observed in 5 (17 %) patients. Patients with 2 or more co-morbidities had significantly more early period complications (p=0.02). Patients who were older than 60 years had more early and late period complications compared to patients who were less than 60 year-old (p=0.05 and p=0.03, respectively). More early period complications were observed in cases with the surgical time longer than 180 minutes and estimated blood loss more than 900 ml (p=0.02 and p=0.03, respectively). The patients with more than 2 fused segments had more late period complications (p=0.04).

Conclusions:

Instrumented posterolateral fusion applied to patients with degenerative lumbar spondylolisthesis who are older than 60 years, have more than two co-morbidities and if the surgical time is longer than 180 minutes and estimated blood loss is more than 900 ml the surgeon should be alert againts early period complications. If the patient with more than two fused segments is older than 60 years the surgeon should be aware of late period complications.