Spine surgeon performs spinal fusion on 95-year-old patient

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Vijay Yanamadala, MD, of Hartford (Conn.) HealthCare spoke with Becker's about a recent spine case he performed on an older patient.

Note: This conversation was lightly edited for clarity.

Question: You recently performed a spinal fusion on a 95-year-old patient. How did that case go?

Dr. Vijay Yanamadala: So this gentleman, unbeknownst to him, had ankylosing spondylitis. He unfortunately had a fall at home really just from standing and had developed a bad three-column fracture of the thoracic spine. He came to the emergency room, fortunately still neurologically intact, and we did the imaging. So I had to do a multilevel fusion for him to stabilize this in the setting of ankylosing spondylitis. This was not an awake surgery. However, I'd love to do these types of surgeries awake, but we haven't necessarily started doing multilevel fusions awake. The man was 95 years old, and [we] did extensive preoperative optimization and clearance for him with our medical teams before we took him to surgery.

Q: What was the biggest challenge with this procedure?

VY: This was an extensive conversation with him and his family. He was high functioning, he was active, and what we said is that without getting surgery, he would basically be bed-bound because of this unstable fracture. You know, what we know about ankylosing spondylitis is if the patient really gets up and walks without stabilization, that patient could become paralyzed due to movement of the fracture and injury to the spinal cord. So we basically had that conversation and the patient said, "I'm used to being mobile. I'm used to being independent and living alone." So we wanted to really get him back to that functional state. And the only way we could do that is through surgery, not through bracing or really any other means. Could we stabilize this adequately to get him walking?

Q: How have the outcomes been?

VY: He's doing very well. He's actually back home. He's independent. He has really had a remarkable recovery, especially given his age. So he's very, very happy with how things are going.

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