Study Design: Retrospective study of registry data. Objectives: Aging of society and recent advances in surgical techniques and general anesthesia have increased the demand for spinal surgery in elderly patients. Many complications have been described in elderly patients, but a multicenter study of perioperative complications in spinal surgery in patients aged 80 years or older has not been reported. Therefore, the goal of the study was to analyze complications associated with spine surgery in patients aged 80 years or older with cervical, thoracic, or lumbar lesions. Methods: A multicenter study was performed in patients aged 80 years or older who underwent 262 spinal surgeries at 35 facilities. The frequency and severity of complications were examined for perioperative complications, including intraoperative and postoperative complications, and for major postoperative complications that were potentially life threatening, required reoperation in the perioperative period, or left a permanent injury. Results: Perioperative complications occurred in 75 of the 262 surgeries (29%) and 33 were major complications (13%). In multivariate logistic regression, age over 85 years (hazard ratio [HR] = 1.007, P = 0.025) and estimated blood loss ≥500 g (HR = 3.076, P = .004) were significantly associated with perioperative complications, and an operative time ≥180 min (HR = 2.78, P = .007) was significantly associated with major complications. Conclusions: Elderly patients aged 80 years or older with comorbidities are at higher risk for complications. Increased surgical invasion, and particularly a long operative time, can cause serious complications that may be life threatening. Therefore, careful decisions are required with regard to the surgical indication and procedure in elderly patients.

Study Design. Segmental arteries including the level of Adamkiewicz artery were interrupted bilaterally for up to 4 levels to study the effects on spinal cord blood flow and neurologic function in dogs. Objective. To examine how many ligations of bilateral segmental arteries including the level of Adamkiewicz artery cause ischemic spinal cord dysfunction. Summary of Background Data. Interruption of bilateral segmental arteries at ≥5 consecutive levels without the level of Adamkiewicz artery has been reported to risk producing ischemic spinal cord dysfunction in dog model. However, the effects of ligating including the level of Adamkiewicz artery have not been elucidated. Methods. The 25 dogs in which Adamkiewicz artery originated from L5 level were taken in this study. There were 15 dogs divided into 5 groups: sham group, no ligation; group 1, ligation of bilateral segmental arteries at 1 level (L5); group 2, at 2 levels (L4–L5); group 3, at 3 levels (L4–L6); and group 4, at 4 levels (L3–L6). Spinal cord blood flow at the L5 spinal cord segment by laser-Doppler flowmetry, and spinal cord-evoked and compound muscle action potentials were measured simultaneously until 10 hours after ligation. Neurologic function was assessed using a modified Tarlov grading system 1 week after operation in 10 other dogs divided into 2 groups: 3 pairs group, ligation at 3 levels (L4–L6); 4 pairs group, at 4 levels (L3–L6). Results. Spinal cord blood flow was 98.2%, 76.1%, 66.6%, 61.4%, and 53.5% in the sham group, groups 1, 2, 3, and 4, respectively, 10 hours after ligation. Abnormal spinal cord-evoked and compound muscle action potentials were observed in 1 out of 3 dogs in group 4. Postoperative neurologic evaluation identified all 5 dogs in 3 pairs group and 4 in 4 pairs group as having grade 5. There was 1 dog in 4 pairs group that had grade 4. Conclusion. Interruption of bilateral segmental arteries at ≥4 consecutive levels including the level of Adamkiewicz artery risks producing ischemic spinal cord dysfunction.

Study Design. Ten patients with a spinal tumor of the lower lumbar spine underwent total en bloc spondylectomy (TES) by combined posterior-anterior approach. The oncological and neurologic results are analyzed. Objective. To describe the surgical technique and evaluate the clinical outcome of this surgery. Summary of the Background Data. TES at lower lumbar spine is technically challenging because of its anatomy such as the presence of major vessels and lumbosacral plexus nerves. Methods. Six aggressive benign tumors and 4 solitary spinal metastases involving L4 or L5 were treated. The approache of operative procedure are discussed as follows: Posterior approach: Dissection of the lumbar nerve roots to the conjunction of the adjacent nerves were performed after en bloc laminectomy by T-saw pediculotomy. The psoas muscle was dissected away, from the vertebral body. The posterior halves of the anterior column at the craniocaudal adjacent levels of the lumbar tumor were cut. Anterior approach: Major vessels were dissected from the vertebral body. Anterior halves of the anterior column were cut at the corresponding levels. The tumor vertebral body was removed en bloc, followed by anterior spinal reconstruction. Results. Seven of 10 cases had no evidence of disease at 57 months on average, 1 case was alive with disease at 66 months, 1 case had death of disease at 42 months, and 1 case had death of another disease at 14 months after surgery. All patients improved or preserved neurologic in the last follow up. The resected specimen of vertebral bodies and laminae showed marginal or wide margin in all cases, although pedicles showed intralesional margin in 8 cases. No local recurrence was observed during lifetime with mean 52 months. Conclusion. TES for spinal tumor of L4 or L5 preserving lumbar nerves was achieved by combined posterior- anterior approach.

Previous studies have indicated that trunk muscle strength decreases with chronic low back pain, and is associated with poor balance, poor functional performance, and falls in older adults. Strengthening exercises for chronic low back pain are considered the most effective intervention to improve functional outcomes. We developed an innovative exercise device for abdominal trunk muscles that also measures muscle strength. The correlation between muscle weakness, as measured by our device, the presence of chronic low back pain, and decreased physical ability associated with a risk of falling were evaluated in older women. Thirty-eight elderly women, who could walk without support during daily activities and attended our outpatient clinic for treatment of chronic low back pain, knee or hip arthritis, or osteoporosis, were included in this study. Anthropometric measurements were performed. Grip power and one-leg standing time with eyes open were measured, and abdominal trunk muscle strength was measured using our device. History of falling in the previous 12 months was noted. Subjects with chronic low back pain (visual analog scale score ≥ 20 mm) for over 3 months were assigned to the low back pain group (n = 21). The remaining subjects formed the non-low back pain group (n = 17). Abdominal muscle strength of subjects in the low back pain group, and with history of falling, was significantly lower compared with that of subjects in the non-low back pain group, and in subjects without a history of falling, respectively. There was a moderate positive correlation between abdominal trunk muscle strength and one-leg standing time with eyes open. We measured abdominal muscle strength in older women with chronic low back pain using our device, and it was significantly lower than that of those without chronic low back pain. Muscle weakness was associated with a history and risk of falling.

Several studies have evaluated the efficacy of preoperative embolization in devascularizing tumors. However, no study has measured intraoperative blood loss in a single palliative surgery compared with a control group without preoperative embolization. The purpose of this retrospective study was to evaluate the efficacy of preoperative embolization on intraoperative blood loss in palliative decompression and instrumented surgery using a posterior approach for spinal metastasis. Between 2000 and 2010, forty-six patients underwent palliative decompression and instrumented surgery using a posterior approach for spinal metastasis in the thoracic and lumbar spine. Preoperative embolization was performed in 23 patients (embolization group), and surgery was performed within 3 days after embolization. The embolic materials used were polyvinyl alcohol particles, gelatin sponge, and metallic coils. Twenty-three patients did not undergo embolization (no embolization group). Pain and neurologic symptoms in all 46 patients were relieved postoperatively. Average intraoperative blood loss was 520 mL (range, 140–1380 mL) in the embolization group and 1128 mL (range, 100–3260 mL) in the no embolization group ( P <.05). In the embolization group, intraoperative blood loss was not correlated with the degree of tumor vascularization, completeness of embolization, or time between embolization and surgery. Intraoperative blood loss after preoperative embolization was less than half that after no preoperative embolization.