SURGICAL TREATMENT OF ELDERLY AND SENILE PATIENTS WITH DEGENERATIVE CENTRAL LUMBAR SPINAL STENOSIS

Abstract

Objective. To analyze the results of surgical treatment of patients of the older age group with central spinal stenosis at the lumbar level. Material and Methods. A total of 107 patients of elderly and senile age with clinically significant degenerative central stenosis of the spinal canal were treated. They were divided into two groups: patients in Group 1 underwent bilateral decompression of nerve roots through unilateral approach; those in Group 2 - nerve root decompression supplemented with interbody fusion and transpedicular fixation. Results. The surgery resulted in statistically significant reduction in pain, improvement of the quality of life, enlargement of spinal canal dimension parameters, and increase in the distance of walking. Statistical difference in the quality of life between Groups 1 and 2 was revealed for the indicator characterizing the psychological component of the SF-36 questionnaire (p = 0.03); there were no statistical differences for the remaining indicators. The key parameter for assessing central stenosis is the cross-sectional area of the dural sac. Conclusion. Preoperative examination of patients of the older age group should be comprehensive and include CT myelography with 3D reconstruction. The cause of nerve root compression in central stenosis is a combination of various factors in 41.9 % of cases. Differential surgical tactics provides an improvement in the quality of life in 80 % of cases. Excessive decompression does not improve the quality of life of patients. Instrumental fixation does not improve the outcome of surgical intervention and should be used only for clinically significant instability of the spinal motion segment.