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    Age and lumbar surgery -: Response
    (Amer Assoc Neurological Surgeons, 2005) Kilinçer, C; Sohn, MJ; Steinmetz, MP; Benzel, EC; Bingaman, W
    [Abstract Not Available]
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    Biornechanical evaluation of the ventral and lateral surface shear strain distributions in central compared with dorsolateral placement of cages for lumbar interbody fusion
    (Amer Assoc Neurological Surgeons, 2006) Sohn, MJ; Kayanja, MM; Kilinçer, C; Ferrara, LA; Benzel, EC
    Object. The purpose of this study was to measure and compare the ventral and lateral surface strain distributions and stiffness for two types of interbody cage placement: 1) central placement for anterior lumbar interbody fusion (ALIF); and 2) dorsolateral placement for extraforaminal lumbar interbody fusion (ELIF). Methods. Two functional spine units were obtained for testing in each of 13 cadaveric spines, yielding 26 segments (three of which were not used because of bone abnormalities). Bilateral strain gauges were mounted adjacent to the endplate on the lateral and ventral walls of each vertebral body in the 23 motion segments. Each segment was cyclically tested in compression, flexion, and extension in the following conditions: while intact, postdiscectomy, and instrumented with interbody fusion cages placed using both insertion techniques. No significant differences were observed between ALIF and ELIF in compressive stiffness, bending stiffness in flexion and extension (p >= 0.1), ventral and lateral strain distribution during the intact tests (p >= 0.24), and during the flexion tests after fusion (p >= 0.22). In compression, higher ventral and lower lateral strain was observed in the ALIF than in the ELIF group (ventral, p = 0.05; lateral, p = 0.04), and in extension, higher ventral (p = 0.01) and higher lateral strain (p = 0.002) was observed in the ELIF than in the ALIF group. Conclusions. Preservation of the ventral anulus and dorsolateral placement of the interbody cages during ELIF allow alternate load transfer pathways through the dorsolateral vertebral wall and ventral anulus that are not observed following ALIF. These may be associated with a lower incidence of subsidence and a higher rate of fusion due to a more concentrated application of bone healing-enhancing compression forces during the fusion and healing process.
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    Effects of age on the perioperative characteristics and short-term outcome of posterior lumbar fusion surgery
    (Amer Assoc Neurological Surgeons, 2005) Kilinçer, C; Steinmetz, MP; Sohn, MJ; Benzel, EC; Bingaman, W
    Object. Although advances in patient care have enabled surgeons to perform posterior lumbar decompression and fusion (PLDF), increased age remains a major concern when designing a treatment strategy. The authors conducted a study to evaluate if increased age has any effect on lumbar fusion surgery in terms of perioperative events. Methods. This retrospective study comprised 129 patients (age range 25-91 years) with spondylolisthesis, lumbar stenosis and/or disc degeneration/hemiation with instability, or unsuccessful results after a failed previous PLDF. The patients were stratified by age: those younger than 65 years of age (85 patients) and those at least 65 years of age (44 patients). The parameters reviewed included comorbid conditions, American Society of Anesthesiologists score, instrumentation technique (pedicle screws, a combination of pedicle screw fixation [PSF] and posterior lumbar interbody fusion [PLIF], or non-instrumented fusions), number of fused levels, operative time, estimated blood loss (EBL), complications, and hospital length of stay (LOS). Fusion strategies in the elderly tended to be more conservative. Repeated operations and PSF/PLIF procedures were less frequent in the older age group. Older age did not result in increased complications, EBL, and operative time. Longer hospital LOS was observed in the older age group (7 +/- 3.5 days) compared with the younger age group (5.5 +/- 1.9 days) (p = 0.022). Conclusions. Complications and perioperative events following PLDF in the elderly are comparable with those observed in younger patients. Withholding lumbar spine fusion solely based on advanced age is not warranted.