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Minimally Invasive Spine Surgery in the Elderly

  • Oliver Tannous
  • R. Todd AllenEmail author
Chapter

Abstract

Spine surgery in the elderly population is associated with an increased complication rate compared to the younger population, due to the presence of comorbidities, poor bone quality, as well as a decreased physiologic reserve. As our population ages, an asymmetric increase in those over 65 years is occurring, placing higher demands on society and surgeons to treat increasingly severe spinal pathologies in older and sometimes frail patients. At present, there continues to be a lack of level 1 evidence comparing minimally invasive procedures to traditional open techniques in the geriatric population. However, level 2 and 3 evidence suggests that minimally invasive surgery (MIS) of the spine in the elderly (and younger) population lowers complication rates, allows faster surgical recovery rates, and produces equivalent outcomes, for many common spine procedures in this patient population. Specifically related to the elderly, available literature supports MIS decompressions for cervical and lumbar stenosis, MIS discectomy for herniated discs, and lumbar interbody fusions for various pathologies via either lateral lumbar approaches or posterior MIS transforaminal approaches in the elderly population and is therefore a reasonable option and in some cases a better option than traditional open procedures. Furthermore, cortical bone trajectory screws have shown increased pullout strength in osteoporotic bone, as well as minimize the need for extensive posterior exposure. MIS techniques continue to evolve, including advances in endoscopic decompression as well as mini-open decompression and fusion. It is important for spine surgeons to evolve with these advances in order to optimize the surgical treatment of spine pathology in the elderly population.

Keywords

Minimally invasive spine surgery Geriatric spine surgery Fusion in the elderly Minimally invasive fusion Minimally invasive decompression Endoscopic decompression Endoscopic spine surgery Lateral lumbar interbody fusion MIDLIF Cortical bone trajectory screw 

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of OrthopaedicsGeorgetown University HospitalWashingtonUSA
  2. 2.Department of Orthopaedic SurgeryUniversity of California, San DiegoLa JollaUSA

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