DEGENERATIVE DYSTROPHIC DISEASES OF THE LUMBAR SPINE AND THEIR SURGERY IN ELDERLY AND SENILE PATIENTS
https://doi.org/10.14531/ss2006.3.52-58
Abstract
Objective. Comparative assessment of decompression and decompression-stabilization techniques for degenerative diseases of the lumbar spine in elderly and senile patients.
Material and Methods. A total of 106 patients at the age of 60 to 83 years (mean age 65.7 years) operated on for degenerative disease of the lumbar spine were included in the prospective study. The outcomes were evaluated in 3–4 and 12–24 months. A dynamics of neurologic state, intensity of pain according to VAS, and functional activity according to Oswestry scores were evaluated.
Results. Good results were achieved in 70 % of cases after decompression – stabilization surgery, as compared to 46 % after decompression only. There were 26 % of unsatisfactory results of treatment after decompression, and 5 % – after decompression and stabilization. Surgical complications were typical for these kinds of surgical interventions. There were no infectious and systemic complications as well as metal implant induced complications such as its destruction, migration or subsidence, and bone resorption around implant.
Conclusion. Decompression and stabilization surgery is the most reasonable and effective technique for treatment of lumbar degenerative diseases in elderly and senile patients. Preference should be given to posterior approach surgery concluded by stabilization of operated vertebral segments.
About the Authors
Aleksandr Evgenyevich Simonovich
Novosibirsk Research Institute of Traumatology and Orthopaedics
Russian Federation
Russian Federation
Dmitry Mikhailovich Kozlov
Novosibirsk Research Institute of Traumatology and Orthopaedics
Russian Federation
Russian Federation
References
1. Агеенко А.М., Кирилина С.И., Лебедева Д.М. и др. Анестезиологическое обеспечение хирургического лечения дегенеративных заболеваний позвоночника у пожилых людей // Хирургия позвоночника. 2004. № 4. С. 103−106.
2. Каплан А.В. Травматология пожилого возраста. М., 1977.
3. Луцик А.А. Грыжи межпозвонковых дисков // Нейротравматология: Справочник. М., 1994. С. 240–241.
4. Симонович А.Е., Козлов Д.М., Ермеков Т.Ж. Особенности дегенеративных поражений поясничного отдела позвоночника у пациентов пожилого и старческого возраста // Хирургия позвоночника. 2006. № 2. С. 6–11.
5. Atlas S.J., Keller B.R., Robson D., et al. Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the Maine lumbar spine study // Spine. 2000. Vol. 25. P. 556–562.
6. Berney J. [Epidemiology of narrow spinal canal] // Neurochirurgie. 1994. Vol. 40. P. 174–178. French.
7. Dall B.E., Rowe D.E. Degenerative spondylolisthesis. Its surgical management // Spine. 1985. Vol. 10. P. 668–672.
8. Deyo R.A., Cherkin D.C., Loeser J.D., et al. Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure // J. Bone Joint Surg. Am. 1992. Vol. 74. P. 536–543.
9. Epstein N.E., Epstein J.A., Carras R., et al. Degenerative spondylolisthesis with an intact neural arch: a review of 60 cases with an analysis of clinical findings and the development of surgical management // Neurosurgery. 1983. Vol. 13. P. 555–561.
10. Guiot B.H., Khoo L.T., Fessler R.G. A minimally invasive technique for decompression of the lumbar spine // Spine. 2002. Vol. 27. P. 432–438.
11. Herron L.D., Trippi A.C. L4-5 degenerative spondylolisthesis. The results of treatment by decompressive laminectomy without fusion // Spine. 1989. Vol. 14. P. 534–538.
12. Johnsson K.E., Willner S., Pettersson H. Analysis of operated cases with lumbar spinal stenosis // Acta Orthop. Scand. 1981. Vol. 52. P. 427–433.
13. Jonsson B., Stromqvist B. Lumbar spine surgery in the elderly. Complications and surgical results // Spine. 1994. Vol. 19. P. 1431–1435.
14. Kaneda K., Kazama H., Satoh S., et al. Follow-up study of medial facetectomies and posterolateral fusion with instrumentation in unstable degenerative spondylolisthesis // Clin Orthop. Relat. Res. 1986. N 203. P. 159–167.
15. Katz J.N., Lipson S.J., Brick G.W., et al. Clinical correlates of patient satisfaction after laminectomy for degenerative lumbar spinal stenosis // Spine. 1995. Vol. 20. P. 1155–1160.
16. Katz J.N., Lipson S.J., Larson M.G., et al. The outcome of decompressive laminectomy for degenerative lumbar stenosis // J. Bone Joint Surg. Am. 1991. Vol. 73. P. 809–816.
17. Kazunori Y., Takashi S., Yosihisa K., et al. Indication of fusion for lumbar dpinal stenosis in elderly patients and its Significance // Spine. 1996. Vol. 21. P. 242–248.
18. Kleeman T.J., Hiscoe A.C., Berg E.E. Patient outcomes after minimally destabilizing lumbar stenosis decompression: the "Port-Hole" technique // Spine. 2000. Vol. 25. P. 865–870.
19. Lee C.K. Lumbar spinal instability (olisthesis) after extensive posterior spinal decompression // Spine. 1983. Vol. 8. P. 429–433.
20. PaineK.W. Results of decompression for Lumbar spinal stenosis // Clin. Orthop. Relat. Res. 1976. N 115. P. 96–100.
21. Ragab A.A., Fye M.A,. Bohlman H.H. Surgery of the lumbsr spine for spinal stenosis in 118 patients 70 years of age or older // Spine. 2003. Vol. 28. P. 348–353.
22. Sanderson P.L., Wood P.L. Surgery for lumbar spinal stenosis in old people // J. Bone Joint Surg. Br. 1993. Vol. 75. P. 393–397.
23. Silvers H.R., Lewis P.J., Asch H.L. Decompressive lumbar laminectomy for spinal stenosis // J. Neurosurg. 1993. Vol. 78. P. 695–701.
24. Stoll J.E., Oldridge N.B., Juan Z., et al. Surgery benefits lifespan // Orthopedics Today. 1993. Vol. 2. P. 22–23.
25. Wiltse L.L., Kirkaldy-Willis W.H., McIvor G.W. The treatment of spinal stenosis // Clin. Orthop. Relat. Res. 1976. N 115. P. 83–91.
Review
For citations:
Simonovich A.E., Kozlov D.M. DEGENERATIVE DYSTROPHIC DISEASES OF THE LUMBAR SPINE AND THEIR SURGERY IN ELDERLY AND SENILE PATIENTS. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2006;(3):052-058. (In Russ.) https://doi.org/10.14531/ss2006.3.52-58
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