SPECIFIC FEATURES OF DEGENERATIVE LUMBAR SPINE DISEASE IN ELDERLY AND SENILE PATIENTS
https://doi.org/10.14531/ss2006.2.6-11
Abstract
Objective. To study clinical and morphological features of degenerative lumbar spine disease in elderly and senile patients for substantiation of optimal surgical treatment.
Material and Methods. Prospective study included 128 consecutive patients operated for lumbar spine degeneration during 2003–2005. Patients were divided into two age groups: 88 patients of 60–83 years of age (mean 65.7 years) and 40 patients of 19–40 years of age (mean 31.8 years). Complex diagnosis consisted of anamnestic, general clinical, neurological, X-ray, MRI, and CT examinations.
Results. Patients with clinical manifestations of segmental instability and neurogenic intermittent claudication syndrome prevailed in the older group. Clinical symptoms in elderly patients were associated primarily with degenerative stenosis of the spinal canal. Radiological and CT signs of segmental instability (or hypermobility) were more frequent in older age group than in young patients. Degenerative spondylolisthesis and degenerative scoliosis of the lumbar spine were found only in elderly patients (20.4 % and 21.5 % of cases, respectively). Segmental hypermobility in elderly patients was presented predominantly as a linear translation of vertebrae. Sagittal translation of vertebrae over 3 mm was registered in 54.5 % of older age group patients and only in 22.5 % of young ones (р < 0,01). Flexion-extension hyperangulation of damaged spine segments was found in 61.3 % of older patients and in 65.0 % of young ones.
Conclusion. It may be assumed that surgical treatment of degenerative lumbar spine disease in elderly and senile patients should involve not only extensive decompression of neurovascular formations but also stabilization of damaged spine segments despite a higher risk and implementation difficulties of the surgery.
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
T. Zh. Ermekov
Novosibirsk Research Institute of Traumatology and Orthopaedics
Russian Federation
Russian Federation
References
1. Васильев А.Ю. Компьютерная томография в диагностике дегенеративных изменений позвоночника. М., 2000.
2. Жарков П.Л. Остеохондроз и другие дистрофические изменения позвоночника у взрослых и детей. М., 1994.
3. Каплан А.В. Травматология пожилого возраста. М., 1977.
4. Кузнецов В.Ф. Стеноз поясничного позвоночного канала: Новая концепция в вертебрологии. Минск, 1992.
5. Луцик А.А. Грыжи межпозвонковых дисков // Нейротравматология: Справочник. М., 1994. С. 240–241.
6. Тагер И.Л., Мазо И.С. Рентгенодиагностика смещений поясничных позвонков. М., 1979.
7. Хвисюк Н.И, Чикунов А.С., Арсений А.К. Дегенеративный спондилолистез. Кишинев, 1986.
8. Чеботарев Д.Ф., Маньковский Н.Б. Справочник по гериатрии. М., 1973.
9. Atlas S.J., Keller R.B., 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.
10. Berney J. [Epidemiology of narrow spinal canal] // Neurochirurgie. 1994. Vol. 40. P. 174–178.
11. Dall B.E., Rowe D.E. Degenerative spondylolisthesis. Its surgical management // Spine. 1985. Vol. 10. P. 668–672.
12. Frymoyer J.W., Gordon S.L. New perspectives on low back pain. Basic science perspectives. Park Ridge, IL: American Academy of Orthopaedic Surgeons, 1988.
13. Fujii K., Henmi T., Kanematsu Y., et al. Surgical treatment of lumbar disc herniation in elderly patients // J. Bone Joint Surg. Br. 2003. Vol. 85. P. 1146–1150.
14. Fujiwara A., Tamai K., An H.S., et al. The relationship between disc degeneration, facet joint osteoarthritis, and stability of the degenerative lumbar spine // J. Spinal. Disord. 2000. Vol. 13. P. 444–450.
15. Herkowitz H.N. Spine update. Degenerative lumbar spondylolisthesis // Spine. 1995. Vol. 20. P. 1084–1090.
16. Herron L.D., Trippi A.C. L4–L5 degenerative spondylolisthesis. The results of treatment by decompressive laminectomy without fusion // Spine. 1989. Vol. 14. P. 534–538.
17. Iguchi T., Kurihara A., Nakayama J., et al. Minimum 10-year outcome of decompressive laminectomy for degenerative lumbar spinal stenosis // Spine. 2000. Vol. 25. P. 1754–1759.
18. Iguchi T., Kanemura A., Kasahara K., et al. Age distribution of three radiologic factors for lumbar instability: probable aging process of the instability with disc degeneration // Spine. 2003. Vol. 28. P. 2628–2633.
19. Jonsson B., Stromqvist B. Influence of age on symptoms and signs in lumbar disc herniation // Eur. Spine J. 1995. Vol. 4. P. 202–205.
20. Katz J.N., Lipson S.J., LarsonM.G., et al. The outcome of decompressive laminectomy for degenerative lumbar stenosis // J. Bone Joint Surg. Am. 1991. Vol. 73. P. 809–816.
21. Katz J.N., Lipson S.J., Chang L.C., et al. Seven-to 10-year outcome of decompressive surgery for degenerative lumbar spinal stenosis // Spine. 1996. Vol. 21. P. 92–98.
22. Kent D.L., Haynor D.R., Larson E.B., et al. Diagnosis of lumbar spinal stenosis in adults: a metaanalysis of the accuracy of CT, MR, and myelography // AJR Am. J. Roentgenol. 1992. Vol. 158. P. 1135–1144.
23. Kirkaldy-Willis W.H., Farfan H.F. Instability of the lumbar spine // Clin. Orthop. Relat. Res. 1982. N 165. P. 110–123.
24. Lee C.K. Lumbar spinal instability (olisthesis) after extensive posterior spinal decompression // Spine. 1983. Vol. 8. P. 429–433.
25. Morgan F.P., King T. Primary instability of lumbar vertebrae as a common cause of low back pain // J. Bone Joint Surg. Br. 1957. Vol. 39. P. 6–22.
26. Nachemson A.L., Schultz A.B., Berkson M.H. Mechanical properties of human lumbar spine motion segments. Influence of age, sex, disc level, and degeneration // Spine. 1979. Vol. 4. P. 1–8.
27. Ono T., Tsuchiya T., Horiuchi S., et al. [Radiological study of spinal instability after surgery for lumbar disc herniation] // Orthop. Surg. Traumatol. 1991. Vol. 34. P. 619–624. (Japanese).
28. Paine K.W. Results of decompression for lumbar spinal stenosis // Clin. Orthop. Relat. Res. 1976. N 115. P. 96–100.
29. Posner I., White A.A. 3rd, Edwards W.T., et al. A biomechanical analysis of the clinical stability of the lumbar and lumbosacral spine // Spine. 1982. Vol. 7. P. 374–389.
30. Rosenberg N.J. Degenerative spondylolisthesis. Predisposing factors // J. Bone Joint Surg. Am. 1975. Vol. 57. P. 467–474.
31. Thompson J.P., Pearce R.H., Schechter M.T., et al. Preliminary evaluation of a scheme for grading the gross morphology of the human intervertebral disc // Spine. 1990. Vol. 15. P. 411–415.
32. Verbiest H. A radicular syndrome from developmental narrowing of the lumbar vertebral canal // J. Bone Joint Surg. Br. 1954. Vol. 36. P. 230–237.
33. Yone K., Sakou T., Kawauchi Y., et al. Indication of fusion for lumbar spinal stenosis in elderly patients and its significance // Spine. 1996. Vol. 21. P. 242–248.
Review
For citations:
Simonovich A.E., Kozlov D.M., Ermekov T.Zh. SPECIFIC FEATURES OF DEGENERATIVE LUMBAR SPINE DISEASE IN ELDERLY AND SENILE PATIENTS. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2006;(2):006-011. (In Russ.) https://doi.org/10.14531/ss2006.2.6-11
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