Local foraminotomy for decompression as a factor of the spinal motion segment instability development in elderly patients with degenerative scoliosis
https://doi.org/10.14531/ss2019.4.45-53
Abstract
Objective. To identify the risk of the spinal motion segment instability after local foraminotomy in elderly and senile patients with lumbar spinal stenosis associated with degenerative scoliosis.
Material and Methods. A prospective study included data on 50 patients treated by surgery and 50 patients who underwent conservative treatment in 2013–2017 for leg pain associated with degenerative scoliosis and secondary spinal stenosis. All patients were older than 60 years. Conservative treatment was carried out using vascular drugs, NSAIDs, analgesics, decongestants, and various blockades. In surgery group, patients underwent local foraminotomy for decompression at the involved levels. The average postoperative follow-up period was 3.8 years (from 6 months to 4 years). The study was performed using four-field tables to determine the relative risk.
Results. The performed studies showed that there is no statistically significant risk of instability of the spinal motion segment after foraminotomy in the lumbar spine.
Conclusion. Local foraminotomy in the lumbar spine is not a risk factor for instability in the spinal motion segment. Local foraminotomy in the area of lumbar spinal stenosis combined with degenerative scoliosis can be recommended for the treatment of patients only in the absence of proven instability in the involved spinal motion segment at the preoperative stage.
Material and Methods. A prospective study included data on 50 patients treated by surgery and 50 patients who underwent conservative treatment in 2013–2017 for leg pain associated with degenerative scoliosis and secondary spinal stenosis. All patients were older than 60 years. Conservative treatment was carried out using vascular drugs, NSAIDs, analgesics, decongestants, and various blockades. In surgery group, patients underwent local foraminotomy for decompression at the involved levels. The average postoperative follow-up period was 3.8 years (from 6 months to 4 years). The study was performed using four-field tables to determine the relative risk.
Results. The performed studies showed that there is no statistically significant risk of instability of the spinal motion segment after foraminotomy in the lumbar spine.
Conclusion. Local foraminotomy in the lumbar spine is not a risk factor for instability in the spinal motion segment. Local foraminotomy in the area of lumbar spinal stenosis combined with degenerative scoliosis can be recommended for the treatment of patients only in the absence of proven instability in the involved spinal motion segment at the preoperative stage.
About the Authors
D. A. Mikhailov
Vreden Russian Research Institute of Traumatology and Orthopаedics
Russian Federation
Russian Federation
MD, PhD, neurosurgeon, Department of Neuroorthopaedics and Bone Oncology
8, Akademika Baikova str., St. Petersburg, 195427, Russia
D. A. Ptashnikov
Vreden Russian Research Institute of Traumatology and Orthopаedics,
Mechnikov North-Western State Medical University
Russian Federation
Russian Federation
DMSc, Prof., Head of the Department of Neuroorthopaedics and Bone Oncology; Head of the Department and the Clinic of Traumatology and Orthopaedics
8, Akademika Baikova str., St. Petersburg, 195427, Russia
41, Kirochnaya str., St. Petersburg, 191015, Russia
S. V. Masevnin
Vreden Russian Research Institute of Traumatology and Orthopаedics
Russian Federation
Russian Federation
MD, PhD, junior researcher, Department of Neuroorthopaedics and Bone Oncology
8, Akademika Baikova str., St. Petersburg, 195427, Russia
O. A. Smekalenkov
Vreden Russian Research Institute of Traumatology and Orthopаedics
Russian Federation
Russian Federation
MD, PhD, junior researcher, Department of Neuroorthopaedics and Bone Oncology
8, Akademika Baikova str., St. Petersburg, 195427, Russia
N. S. Zaborowsky
Vreden Russian Research Institute of Traumatology and Orthopаedics
Russian Federation
Russian Federation
MD, PhD, trauma orthopaedist
8, Akademika Baikova str., St. Petersburg, 195427, Russia
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Review
For citations:
Mikhailov D.A., Ptashnikov D.A., Masevnin S.V., Smekalenkov O.A., Zaborowsky N.S. Local foraminotomy for decompression as a factor of the spinal motion segment instability development in elderly patients with degenerative scoliosis. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2019;16(4):45-53. https://doi.org/10.14531/ss2019.4.45-53
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