Purpose: The comorbidities currently considered to increase surgical risk, particularly in the elderly, include heart disorders, diabetes, asthma, obesity, and chronic obstructive pulmonary disease (COPD). Further characterization of postoperative complications in relation to comorbidities is needed for lumbar decompression with fusion and instrumentation surgery.

Methods: A chart review was conducted on the hospital and office records of 121 patients who underwent this procedure between the years of 2000 and 2003. Comorbidities were evaluated based on their tendency to cause related complications. The rate of wound infections was determined due to their relation to diabetes and obesity.

Results: The age range was 65 to 89 years. Of 121 patients, 96 (79%) had comorbidities, and 12 (12.5%) of these had complications. There were 6 cardiac complications, 6 wound infections, and 2 diabetic challenges (1 patient experienced 3 complications). All 6 cardiac complication patients suffered from cardiac comorbidities. The wound infections presented in diabetics, obese patients, and cardiac disorder patients. Infections occurred in cardiac disorder patients only when diabetes and or obesity were present; 4 infected patients had this combination.

Conclusions: The comorbidity and complication that presented with the highest correlation was heart disorders. There were no associated complications with pulmonary diseases. Surgeons should be increasingly aware of the wound infection threat to their cardiac disorder combined with obesity and or diabetic patients. The low rate of comorbid elderly patients who experienced postoperative complications gives statistical indication of safety for elderly patients to pursue complex lumbar surgery.

Purpose: Instrumentation and cementoplasty have been used individually or synergistically to augment screw fixation for better stabilization. A pilot study was performed to develop a new way to use this relationship to solve problematic screw loosening in both healthy and osteoporotic bone. Results show there may be indication to use the following characterized method.

Methods: In 12 cases of patients, pedicle fixation was used for complex decompression. The ages range from 70–85 years and included 8 females and 4 males. All patients underwent a bone tamp bolus formation in cancellous bone through each pedicle at the superior level of construct (3–4 cc. in each site, injected under low pressure) followed by pedicle screw insertion into the bolus, and subsequent levels were fixated by only pedicle screws.

Results: The preoperative, postoperative, and 3 month follow-up plain x-ray films were evaluated for stable bone tamp implantation, cement leakage, and screw placement. In all 12 cases there was no evidence of screw migration, pull-out, fracture, spinal cord compression, nerve root compression, or complication with cement placement. There was no example of cement extrusion into spinal canal. All patients had uneventful recoveries which included physical therapy, mild analgesics, and bracing.

Conclusion: This new technique may solve the problem of loosening of screws in healthy and osteoporotic bone by providing a more secure anchorage system not yet seen in previous studies. Further study is needed to develop more specific outcomes to determine the best technique using the balloon bone tamp system.