Результаты дифференцированного хирургического лечения пациентов пожилого и старческого возраста c латеральным стенозом позвоночного канала на поясничном уровне

Abstract

Objective. To analyze the results of differentiated surgical treatment of elderly and senile patients with lateral stenosis of the lumbar spinal canal. Material and Methods . A total of 95 patients with nerve root compression and back pain were operated on. The analysis and complex evaluation of treatment results were carried out in two groups: Group 1 included 79 (84.15 %) patients with nerve root compression associated with lateral spinal canal stenosis without instability of the spinal motion segment; Group 2 – 16 (15.85 %) patients with clinically significant lateral lumbar spinal canal stenosis with one root compression and severe back pain syndrome caused by the spinal motion segment instability. The clinical and neurological status of patients was evaluated using VAS, ODI, and SF-36 questionnaires. Changes in the angle and depth of the lateral radicular recess and the instability of the spinal motion segment were assessed using CT and functional radiographic findings. Results . Lateral stenosis in elderly and senile patients is presented as a combination of compressing factors in 47.2 % of cases. The increase in the angle of the lateral radicular recess up to 30–40° and in its depth up to 5 mm resulted in reduction of the pain syndrome in the leg and back, and improvement of the quality of life. Conclusion . The use of differentiated surgical treatment tactics based on identification of the dominant clinical neurological syndrome provides good and excellent results in patients of the older age group in 83 % of cases.