A RETROSPECTIVE STUDY OF REPEATED SURGICAL INTERVENTIONS FOR THE LUMBAR INTERVERTEBRAL DISCS HERNIATION IN OLDER PATIENTS

Piontkovskyi V. K.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Due to the demographic processes that occur in modern society treatment of spinal pathology in middleaged and older patients is becoming increasingly relevant with each decade transforming from a medical problem into a social and ethical problem. The essence of this problem is not only in the adequate assessment of the severity of the situation and running a differential diagnostics with natural involuntary changes but also in the choice of optimal treatment technique for a particular patient. In addition, it is necessary to consider the fact that the surgical risk in patients of this age group is much higher than in young patients which is why there is no consensus among experts regarding the treatment of this category of patients. It is common knowledge that in the development of the degenerative cascade of the lumbar spine in older patients stenosis processes with the phenomena of degenerative segmental instability prevail. There is a large number of surgical interventions for the treatment of herniated discs which can be divided into the following groups: decompression (discectomy, microdiscectomy, laminectomy, hemilaminectomy, interlaminectomy and facetectomy), rigid stabilizing, dynamic stabilizing and decompression stabilizing interventions. A big role in providing assistance to this category of patients has recently been played by such percutaneous procedures as epidural adhesiolysis, epidural steroid injections, percutaneous nucleotomy, Stryker disc decompression, laser discectomy, etc. However, there is no consensus regarding the indications for these procedures in middle-aged and older patients, and long-term results do not always satisfy patients. In order to understand the structure of the causes that lead to negative results of surgical treatment in middleaged and older patients we have conducted a retrospective study of repeated surgical interventions in patients who have already had a history of surgical interventions for herniated discs. We have also compared the causes of negative results of the first surgery in young patients and older patients – 60 years and older. The aim of the research is to determine the causes of negative results of surgical treatment of herniated discs in middle-aged and older patients in comparison with young patients which will allow choosing the most appropriate surgical technique and avoid complications. The author conducted a retrospective study of surgical treatment of herniated lumbar intervertebral discs in 170 patients. The study included 92 young patients and 78 older patients (aged over 60). Results of the conducted study reveal that the cause of repeated surgical interventions for herniated intervertebral discs depend on the patient’s age; the most common cause of repeated surgical interventions in older patients is the instability at the operated and adjacent levels which encourages a wider usage of stabilizing surgical interventions and requires a more detailed preoperative planning regarding the choice of the stabilization level; in older patients the processes of stenosis dominate, and therefore, it is necessary to apply a broader decompression; to prevent the development of epidural fibrosis it is necessary to apply atraumatic surgical techniques with minimal intraoperative blood loss; in addition to discectomy older patients often need a correction of degenerative deformities; in identifying critical osteoporosis and in order to prevent the failure of metal structures special implants with cement augmentation should be used to enhance implant-bone contact.

disc herniation, old age

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«Bulletin of problems biology and medicine» Issue 4 part 1 (146), 2018 year, 112-115 pages, index UDK 616.711-018.3:617-08-036.868

10.29254/2077-4214-2018-4-1-146-112-115