TREATMENT OUTCOMES IN ELDERLY AND SENILE PATIENTS WITH DEGENERATIVE DEFORMATIONS AND INSTABILITY OF THE SPINAL COLUMN

Degenerative  scoliosis  is  a  prevalent  issue  among  the  aging  population.  Controversy  remains   over  the  role of surgical intervention in patients with such disease. The authors  present  the results of 14-year experience in treatment of this pathology.  Various approaches  to the surgical treatment depending  on the stage of the disease and the degree of deformation, including  decompression, instrumental posterior spinal fusion, anterior spinal fusion, and osteotomy were examined. Above treatment options are based on the analysis of clinical aspects, mechanical  stability of deformation, the degree of imbalance in the body and causes of pain or neurological  deficit.

The  risk of postoperative complications is extremely  high and seems to be outweighed by the  possible successful outcomes of surgical treatment. The results presented in the treatment of degenerative scoliosis mainly provide positive outcomes and can assist in the selection of treatment for this group of patients.

The purpose of the  study  is to  evaluate  the  treatment outcomes  of elderly  and  senile patients with  degenerative deformations and instability of the spinal column using various surgical techniques.

Material and methods. During  the present  retrospective study the authors  analyzed 437 patients (337 (77%) women and  100  (23%)  men)  aged  60 years  and  older  who  underwent surgical  treatment at  Russian  Research  institute of traumatology and orthopaedics named  after  R.R.Vreden between  2000 and 2016. The  study  group  included  patients with  diseases and consequences  of injuries  in the  spine, leading  to its deformation and following spinal stenosis  with development of neurological  deficit in some cases.

The  patients were subdivided into  four  groups  depending  on surgical  procedure.  Patients in group  I underwent decompression  of neural  structures at affected levels on both  sides without implants  for fixation. This group was used as the  comparison  group.  Patients in group  II  underwent fixation  the  affected  spinal  motion  segments  locally  with transpedicular system without correction of deformity  and with decompression  of neural structures at the level of spine stenosis.  Patients of group  III  underwent surgery  for fixation  of affected  PDS  up to lower thoracic  spine using short transpedicular system along with decompression  of the neural  structures and correction of spine deformity.  Patients in group IV underwent surgery  for fixation  of affected PDS  up to upper thoracic  spine using transpedicular system, bone cement, decompression  of neural structures and correction of spine deformity.

The average postoperative follow up was 5 years (from 3 months  to 15 years), 266 patients were followed for more than three years.

Results.  The  best  results   were  obtained  in  group  IV:  good  results   – 57,2%  (60  patients),  satisfactory  40% (42 patients), poor 2,8% (3 patients).

The  worst  results  were  obtained in group  I: after  5 years  follow up satisfactory results  were  observed  in 13,4% (15 patients), poor in 86,6% (97 patients) and no good results were reported.

Conclusion. Thus, the performed  study  and observed outcomes indicate  the rationale for performing a full deformity correction by transpedicular fixation and bone cement, applying all the required  methods  and techniques of osteotomy. This approach  allows to maximally  quickly  achieve  the  desired  treatment outcomes  in mid-and long-term follow up period and to avoid complications and revisions.